PATH Approach to Surgery Prevention

When patients are offered back surgeries, bypass surgeries, and hysterectomies, by and large most of these surgeries are preventable. The algorithm for prevention is as follows:
– Algorithm A: Most of these patients have untreated neuropsychiatric disease: patients are either compulsive, hysterical, chronically anxious, have an atypical seizure disorder, temporal lobe disorder, bipolar disorder, etc. These conditions can be found by QEEG, Millon, Myers Briggs, or by poor patient compliance.


– Algorithm B: These patients misinterpret their pain due to cognitive decline and confusion as evidenced by MMSE impairments, impairments on CNS/VS, WMS, or TOVA that they have poor attention to detail, compliance problems again. In short, they suffer from mild to moderate or severe cognitive decline, or even pre-dementia states either due to medications or illness.
– Algorithm C: The reason these patients go for surgery unnecessarily is other medical comorbidities. They have abnormal blood tests due to illnesses, other drugs, medications. They may have hidden diseases such as developing cancers that are detected on a head-to-toe ultrasound (an improved physical exam). These comorbidities exacerbate their current symptoms found by blood or ultrasound, and some may follow up with MRI, PET, or CT as backup tests. This algorithm goes: ultrasound and blood tests, and then if necessary, PET, CT, MRI, etc. Other comorbidities may include undiagnosed pulmonary disease because of no PFTs, osteoporosis due to poor fitness and detected by a DEXA scan, hidden nerve disease diagnosed by NCVs or EMGs.
The three core surgeries that we will be trying to prevent are: back surgeries, cardiac bypass surgeries, and hysterectomies. The likely algorithm corresponding to each surgery is as follows:
– For back surgeries, it is most likely Algorithm A, and part of Algorithm C that is about DEXA scans since low bone density and poor muscle strength contribute to back pain.
– For bypass surgery, most of this is due to poorly treated coronary artery disease, poorly treated hypertension, untreated mood and anxiety disorders, and other medical comorbidities found by either blood or other diagnostics. Once again this falls into both Algorithms A and C.
– Hysterectomies have a neuropsychiatric and cognitive component. They fall into Algorithms A and B.