Avoid Unnecessary Surgeries: Strategies for Employers

Key Takeaways

• Low-value elective procedures remain a risk when recommendations move to scheduling without a clear pause.

• Independent second opinions are a first step before procedures.

• Employers can equip employees with decision-support benefits that confirm necessity before a procedure is scheduled.

Introduction

Elective surgery recommendations can move forward before need is fully confirmed. However, by making independent clinical review and appropriate alternatives easier to access, employers can support more informed decisions and help employees avoid potentially unnecessary care before they commit to a procedure.

What Counts as Unnecessary Surgery

Unnecessary surgery is any surgical intervention that is not needed, not indicated, or not in a person's best interest when weighed against other options, including conservative measures.

Many people seek a second opinion before committing to a treatment plan or a surgery, especially for non-emergency recommendations. Low-value care research describes selected spine and knee pathways where well-structured rehabilitation can be an appropriate alternative to routine surgery.

How Surgery Decisions Are Changing

Traditional surgery pathways may move quickly from an initial recommendation to scheduling a procedure. A more patient-centered approach creates space to confirm whether surgery is necessary, seek an independent second opinion, and consider appropriate non-surgical treatment options before moving forward.

Traditional vs. Modern Surgery Decision Support Factors

Five Strategies Employers Can Use

Employers are able to support their employees while lowering risk with strategies that include independent review, clear questions, conservative care, experience checks, and red-flag education.

1. Make Independent Second Opinions Easy to Use

Encourage second opinions for elective or non-emergency surgery outside the original practice group. Spine second-opinion programs typically recommend less surgery than first opinions. See second-opinion education.

2. Equip Employees With the Right Questions

Although patient-initiated second opinions will often confirm the original plan, discrepancies can still change care. Share this checklist:

• What is the diagnosis, and what evidence shows surgery is necessary?

• What happens with watchful waiting or delayed surgery?

• Which non-surgical options remain?

• What benefits and risks apply to this specific situation?

• How often does this clinician perform this procedure, and what are typical outcomes?

3. Require a Conservative-Care First Path When Safe

Low-value care research includes high-quality non-surgical care prior to surgery among guideline-recommended musculoskeletal (MSK) approaches. In some spine pathways, routine surgery is not superior to well-structured rehabilitation. Shared decision-making may lead informed people to prefer conservative options.

4. Help Employees Evaluate Clinician Experience

Once the need for surgery is confirmed, benefits leaders can help employees understand what to look for in a qualified clinician or surgical team. Encouraging questions about procedure volume, complication rates, recovery expectations, and typical outcomes can help employees make more informed decisions about their next steps.

5. Teach Red Flags That Signal a Pause

Watch for urgency on chronic non-emergency conditions or imaging-only rationale without matching symptoms. Design surgery benefits around people, not procedures.

The remaining gap is benefits design that turns advice into clinical review, nurse support, and a clear next path.

How Transcarent Helps Employers Avoid Unnecessary Surgeries

Employers can offer clinician-led review and coordinated surgery pathways so elective procedures proceed only when appropriate.

Transcarent Surgery Care starts with multi-step clinical review and nurse-led coordination. When surgery is indicated, Members match to Centers of Excellence (COEs). When it is not, virtual physical therapy can support recovery. Expert medical opinions through 2nd.MD connect Members with specialists by video or phone. Transcarent works with existing health plan benefits.

The WayFinding® platform pairs agentic AI (AI that can take action on a Member's behalf) with clinicians so Members can ask hyper-personalized questions about their surgery options and receive immediate, audited answers. In 2024 Transcarent Book of Business data, 23% of recommended surgeries were avoided through second opinions and conservative care. Results are based on internal program data; individual outcomes may vary. High-quality surgical care should start with upstream guidance, earlier intervention, stronger prevention, and making the complete care journey easier, from first concern to full recovery.

Conclusion

Helping employees confirm whether elective surgery is necessary can support better care decisions while reducing avoidable costs for both employees and health plans. By making independent review, conservative treatment options, and clinical guidance easier to access, benefits leaders can create a more informed path from surgical recommendation to treatment.

To see how Transcarent supports these decisions, you can request a demo today.

Frequently Asked Questions

What is considered unnecessary surgery?

Unnecessary surgery is an operation that is not needed, not indicated, or not in the person's best interest compared with other options, including conservative care.

When should employees seek a second opinion before surgery?

Employees should seek a second opinion for elective or non-emergency recommendations, or whenever diagnosis, alternatives, or expected benefit remain unclear.

How can employers reduce unnecessary surgery in their populations?

Employers can help make independent review easy to use for their employees, build conservative-first pathways when safe, educate on red flags, and route confirmed surgery to high-quality settings.

Which questions help employees evaluate a surgery recommendation?

Employees evaluating a surgery recommendation should ask whether the diagnosis clearly supports surgery, what could happen if they wait, and whether appropriate non-surgical treatments have been tried. They should also understand the expected benefits and risks for their specific situation and ask about the clinician’s experience performing the procedure and typical outcomes.

Does avoiding unnecessary surgery mean avoiding all surgery?

No. The goal is not to avoid surgery, but to make sure it is appropriate and necessary. Time-sensitive or clearly indicated procedures should move forward promptly, while elective or non-emergency recommendations may benefit from an independent review and consideration of appropriate non-surgical options before proceeding.

References

AlAli, K. F. (2023). Unnecessary spine surgery: Can we solve this ongoing conundrum?. Frontiers in Surgery (via PubMed Central).

Barnett, A. I., & Swart, M. (2021). Shared decision making for high-risk surgery. BJA Education (via PubMed Central).

Buchbinder, R., Underwood, M., Hartvigsen, J., & Maher, C. G. (2022). Low-value care in musculoskeletal health care: Is there a way forward?. Pain Practice (via PubMed Central).

Ferreira, G. E., Zadro, J., Liu, C., et al. (2022). Second opinions for spinal surgery: A scoping review. BMC Health Services Research (via PubMed Central).

Greenfield, G., Shmueli, L., Harvey, A., et al. (2021). Patient-initiated second medical consultations: Patient characteristics and motivating factors, impact on care and satisfaction: A systematic review. BMJ Open (via PubMed Central).