Unnecessary Surgeries in India

Key Points

- Research suggests that unnecessary surgeries in Indian hospitals include procedures like caesarian sections, back surgeries, and tonsillectomies, often driven by financial incentives in private facilities.

- It seems likely that the prevalence of such surgeries is higher in private hospitals, with studies indicating up to 44% of recommended surgeries may be unnecessary based on second opinions.

- The evidence leans toward overuse of certain common surgeries, such as caesarian sections, with rates exceeding WHO recommendations, potentially harming patients without medical need.

Background

Unnecessary surgeries refer to medical procedures performed without clear medical indication, often due to factors like financial incentives, lack of second opinions, or over-diagnosis. In Indian hospitals, this issue is particularly noted in private facilities, where profit motives may influence surgical decisions. The World Bank and other studies have highlighted "medical overuse" as a growing concern, especially with increasing access to private health insurance.

Common Unnecessary Surgeries

Based on available data, the most common unnecessary surgeries in Indian hospitals include:

1. Caesarian sections: Rates are high, with studies suggesting one in five women undergo unnecessary C-sections, especially in private hospitals.

2. Back surgeries: Often performed for chronic pain without exhausting non-surgical options, with potential overuse noted in global studies applicable to India.

3. Tonsillectomies: Frequently done for recurrent sore throats, but research suggests many are unnecessary, particularly in children.

4. Appendectomies: Sometimes performed prophylactically without clear evidence of appendicitis.

5. Cardiac stents: A second-opinion center in India found 55% of recommended cardiac stents or surgeries inappropriate.

Unexpected Detail

An interesting finding is that the Indian Medical Association (IMA) has faced criticism for defending unnecessary surgeries, such as in response to surveys showing high rates of unnecessary procedures, rather than addressing the core issue, which highlights tensions between medical ethics and economic interests.

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Survey Note: Detailed Analysis of Unnecessary Surgeries Performed in Indian Hospitals

The issue of unnecessary surgeries in Indian hospitals is a significant public health concern, particularly given the country's large and diverse healthcare system, which includes both public and private facilities. This survey note explores the prevalence, types, and factors contributing to unnecessary surgeries, drawing on available research, reports, and studies, with a focus on the context of Indian hospitals as of March 19, 2025.

Background and Methodology

Unnecessary surgeries are defined as medical procedures performed without a clear medical indication, often driven by factors such as financial incentives, over-diagnosis, or lack of patient awareness.

In India, the healthcare system is characterized by a mix of public and private providers, with private hospitals accounting for a significant share of surgical interventions.

The World Bank, in a 2014 deliberation, concluded that "medical overuse" is emerging as a serious issue, especially with increasing access to private voluntary health insurance, which makes individuals two to three times more likely to be hospitalized than the national average ([Evidence for Overuse of Medical Services Around the World](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708862/)).

This survey analyzes data from various sources, including second-opinion surveys, national health statistics, and academic studies, to identify the most common unnecessary surgeries and their implications.

Prevalence and Context

A notable study by MediAngels.com, an online second-opinion platform, found that of 12,500 patients seeking surgery-related second opinions, 44% were advised that surgery was unnecessary, with more relevant, less invasive treatment options available ([44% advised unnecessary surgery: 2nd opinion-givers | India News](https://timesofindia.indiatimes.com/india/44-advised-unnecessary-surgery-2nd-opinion-givers/articleshow/45746903.cms)). This high rate underscores the prevalence of unnecessary surgeries, particularly in private hospitals, where financial incentives may play a role. Another report highlighted that Indian surgeons have called for an end to unnecessary operations in the private sector, citing "healthcare corruption" as a contributing factor ([Indian surgeons call for end to unnecessary operations in private sector | The BMJ](https://www.bmj.com/content/357/bmj.j1910)).

The Health Management Information System in India recorded over 14 million minor surgeries in 2019-2020, accounting for about a quarter of all surgeries, but specific data on unnecessary procedures is sparse ([Surgical care in India is a neglected part of public health | Explained](https://www.thehindu.com/sci-tech/health/right-to-access-surgery-rural-india-explained/article67388340.ece)). The Lancet Commission for Global Surgery estimated that India needs 5,000 surgeries per 100,000 people to meet the surgical burden, but current rates range from 166 to 3,646 per 100,000, suggesting both underuse and potential overuse in certain contexts.

Common Unnecessary Surgeries

Based on available data, the following surgeries are frequently identified as overused or unnecessary in Indian hospitals:

1. Caesarian Sections: The most performed surgery in India, with rates rising from 17% in NFHS-4 (2015-16) to 21.5% in NFHS-5 (2019-21), exceeding WHO recommendations of 10-15% ([Disparities in Elective and Emergency Caesarean Section Rates Among Public and Private Hospitals in the Districts of Andhra Pradesh, India](https://pmc.ncbi.nlm.nih.gov/articles/PMC10944325/)). A study found that one in five pregnant women in India undergo unnecessary C-sections, particularly in private facilities, driven by "supplier-induced demand" for financial incentives ([India's private hospitals saw 900k unnecessary C-sections in a year: Study](https://www.business-standard.com/article/current-affairs/india-s-private-hospitals-saw-900k-unnecessary-c-sections-in-a-year-study-118120200214_1.html)). This can lead to complications like delayed breastfeeding and respiratory morbidities for newborns.

2. Back Surgeries: Often performed for chronic back pain without exhausting non-surgical options like physical therapy. Global studies suggest up to 60% of recommended spine surgeries may be unnecessary, and this trend is likely applicable in India, given the lack of consensus on management and overreliance on MRI findings ([Unnecessary spine surgery: can we solve this ongoing conundrum?](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491010/)).

3. Tonsillectomies: Commonly performed for recurrent sore throats, but research suggests that 88% of children's tonsillectomies in similar contexts may be unnecessary, with many patients growing out of the condition without surgery ([Nine in 10 operations to remove children's tonsils 'unnecessary' | Health | The Guardian](https://www.theguardian.com/society/2018/nov/06/nine-in-10-operations-to-remove-childrens-tonsils-unnecessary)). In India, tonsillectomy is a frequent procedure, and overuse is plausible, especially in private settings.

4. Appendectomies: Sometimes performed prophylactically or without clear evidence of appendicitis, with studies suggesting a portion may be unnecessary, particularly in cases of mild symptoms manageable with antibiotics.

5. Cardiac Stents and Angioplasties: A second-opinion center in India found 55% of recommended cardiac stents or surgeries inappropriate, indicating significant overuse, often driven by financial incentives in private hospitals ([Evidence for Overuse of Medical Services Around the World](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708862/)).

6. Cataract Surgeries: While necessary for many to prevent blindness, there may be cases of overuse, especially if performed before significant vision impairment, given India's high cataract surgical rate of 6,000 per million in 2012, close to the estimated need of 8,000-8,700 ([Improving cataract services in the Indian context](https://pmc.ncbi.nlm.nih.gov/articles/PMC4069775/)).

7. Hysterectomies: Often performed for non-life-threatening conditions like fibroids, with reports of unnecessary procedures in private hospitals to exploit government insurance schemes, particularly among poor women ([Needless surgeries: Latest News, Videos and Photos of Needless surgeries | Times of India](https://timesofindia.indiatimes.com/topic/needless-surgeries)).

8. Knee and Hip Replacements: Frequently performed for osteoarthritis, but may be unnecessary if non-surgical treatments like physiotherapy are effective, with potential overuse in private facilities.

9. Hernia Repairs: Common procedures, with some cases potentially unnecessary if symptoms are mild and manageable without surgery, especially in elective settings.

10. Arthroscopic Surgeries: For knee and shoulder issues, often performed without clear benefit, with global studies suggesting overuse applicable to India.

Factors Contributing to Unnecessary Surgeries

Several factors contribute to the prevalence of unnecessary surgeries in Indian hospitals:

- Financial Incentives: Private hospitals, where many surgeries occur, may prioritize profit, with surgeons sometimes paid based on the "business" they bring, leading to unnecessary recommendations ([44% advised unnecessary surgery: 2nd opinion-givers | India News](https://timesofindia.indiatimes.com/india/44-advised-unnecessary-surgery-2nd-opinion-givers/articleshow/45746903.cms)).

- Lack of Second Opinions: Patients often trust their doctors without seeking second opinions, and in some cases, hospitals offer tumor board opinions instead of independent assessments, reducing scrutiny.

- Insurance Penetration: Increasing access to private health insurance has led to higher hospitalization rates, with studies showing insured individuals are two to three times more likely to be hospitalized, potentially driving unnecessary interventions.

- Over-Diagnosis and Over-Reliance on Imaging: For back surgeries, over-reliance on MRI findings, which show degenerative changes common in asymptomatic patients, contributes to unnecessary procedures.

Implications and Challenges

Unnecessary surgeries pose risks to patients, including complications, disability, or death, particularly in settings with limited facilities to manage post-operative care. They also divert resources from essential healthcare services, increasing out-of-pocket expenses and potentially pushing families into poverty. The Indian Medical Association (IMA) has faced criticism for defending unnecessary surgeries, such as in response to surveys highlighting the issue, rather than addressing it, which reflects tensions between medical ethics and economic interests ([Why is Indian Medical Association defending unnecessary surgeries?](https://www.dailyo.in/politics/why-is-indian-medical-association-defending-unnecessary-surgeries/story/1/1453.html)). This unexpected detail highlights the complexity of regulating surgical practices in a profit-driven healthcare system.

Comparative Context and Research Insights

Globally, unnecessary surgeries are a known issue, with studies in the US showing up to 30% of certain operations may be unwarranted. In India, the context is unique due to the dual public-private system, with private hospitals showing higher rates of unnecessary procedures. For instance, a study found that women delivering in private facilities are 13.5-14 percentage points more likely to undergo unplanned C-sections compared to public facilities ([India's private hospitals saw 900k unnecessary C-sections in a year: Study](https://www.business-standard.com/article/current-affairs/india-s-private-hospitals-saw-900k-unnecessary-c-sections-in-a-year-study-118120200214_1.html)). This aligns with global trends but is exacerbated by India's healthcare economics, where out-of-pocket expenses account for 70% of medical costs, incentivizing unnecessary interventions.

#### Table: Summary of Common Unnecessary Surgeries in Indian Hospitals

| **Surgery** | **Estimated Unnecessary Rate** | **Key Findings** |

|---------------------------|-------------------------------|---------------------------------------------------------------------------------|

| Caesarian Sections | ~20% in private hospitals | Rates exceed WHO recommendations, driven by financial incentives in private facilities. |

| Back Surgeries | Up to 60% (global estimate) | Over-reliance on MRI, lack of conservative management options. |

| Tonsillectomies | ~88% in children (global) | Often performed for mild recurrent sore throats, many patients grow out of condition. |

| Appendectomies | Variable, some prophylactic | Performed without clear evidence, potentially manageable with antibiotics. |

| Cardiac Stents | 55% inappropriate (India) | Second-opinion center findings indicate significant overuse, especially in private hospitals. |

| Cataract Surgeries | Case-specific, potential overuse | High surgical rates, but some may be performed before significant vision impairment. |

| Hysterectomies | Not quantified, reports of overuse | Unnecessary procedures noted in private hospitals, exploiting insurance schemes. |

| Knee/Hip Replacements | Case-specific, potential overuse | Often performed without exhausting non-surgical options, especially in private settings. |

Conclusion

In conclusion, unnecessary surgeries in Indian hospitals, particularly in private facilities, are a significant issue, with common procedures including caesarian sections, back surgeries, tonsillectomies, and cardiac stents. The evidence suggests overuse is driven by financial incentives, lack of second opinions, and over-diagnosis, with implications for patient safety and healthcare resource allocation. Addressing this requires improved regulation, patient education, and stronger oversight of private hospitals to ensure surgeries are performed only when medically necessary.

Key Citations

- [44% advised unnecessary surgery: 2nd opinion-givers | India News](https://timesofindia.indiatimes.com/india/44-advised-unnecessary-surgery-2nd-opinion-givers/articleshow/45746903.cms)

- [Indian surgeons call for end to unnecessary operations in private sector | The BMJ](https://www.bmj.com/content/357/bmj.j1910)

- [Surgical care in India is a neglected part of public health | Explained](https://www.thehindu.com/sci-tech/health/right-to-access-surgery-rural-india-explained/article67388340.ece)

- [Estimation of the National Surgical Needs in India by Enumerating the Surgical Procedures in an Urban Community Under Universal Health Coverage](https://pmc.ncbi.nlm.nih.gov/articles/PMC7752785/)

- [Doctors perform thousands of unnecessary surgeries](https://amp.usatoday.com/amp/4754433)

- [Evidence for Overuse of Medical Services Around the World](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708862/)

- [India's private hospitals saw 900k unnecessary C-sections in a year: Study](https://www.business-standard.com/article/current-affairs/india-s-private-hospitals-saw-900k-unnecessary-c-sections-in-a-year-study-118120200214_1.html)

- [Improving cataract services in the Indian context](https://pmc.ncbi.nlm.nih.gov/articles/PMC4069775/)

- [Why is Indian Medical Association defending unnecessary surgeries?](https://www.dailyo.in/politics/why-is-indian-medical-association-defending-unnecessary-surgeries/story/1/1453.html)

- [Disparities in Elective and Emergency Caesarean Section Rates Among Public and Private Hospitals in the Districts of Andhra Pradesh, India](https://pmc.ncbi.nlm.nih.gov/articles/PMC10944325/)

- [Nine in 10 operations to remove children's tonsils 'unnecessary' | Health | The Guardian](https://www.theguardian.com/society/2018/nov/06/nine-in-10-operations-to-remove-childrens-tonsils-unnecessary)

- [Unnecessary spine surgery: can we solve this ongoing conundrum?](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491010/)

- [Needless surgeries: Latest News, Videos and Photos of Needless surgeries | Times of India](https://timesofindia.indiatimes.com/topic/needless-surgeries)