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During a recent local NPR broadcast Atul Gawande claimed that Americans have on average seven operations during their life, stating,

“We think in the course of a person’s life, that you will turn to the health system for a few high risk, high failure moments, and also some of the highest cost moments in that system. Childbirth. Surgery. The average American has 7 [sic] operations in their lifetime, all the way to the end of life.”

This same claim has also been repeated in earlier interviews. However, this number seems high or at minimum is lacking a great deal of context. As such, this this an accurate number or is it inaccurate or misleading in some way?

  • if you count C-sections, you have birth, tonsils, & wisdom teeth quite common before about age 21. Another 4 over the next 50-60 years? Sounds plausible. Especially when you start adding-in appendectomies (emergency and elective), additional C-sections (for mothers), gall bladder removal, reconstructive knee operations, stitches for large wounds, lasik, etc. Highly plausible. – warren Jun 21 '13 at 18:57
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Here is the original source of that claim.

Based on the state of medical and surgical practice in 2002, the average American has 3.41 inpatient, 2.56 outpatient, and 3.20 non-OR, for an overall total of 9.17 surgical procedures in an 85-year lifespan.1

The method behind those number was also described. They counted the number of surgical procedures in an 85-year lifespan by summing the rates of surgery for each year between 0 and 84 in Colorado, Florida, and New Jersey based on state databases.1

Citing this work 4 years later, Gawande said, "At the present rate, the average American can expect to undergo seven operations during his or her lifetime."2 Perhaps he did not count the 2.56 outpatient procedures when he claimed "seven operations".

References

1. Peter H.U. Lee and Atul A. Gawande, The number of surgical procedures in an American lifetime in 3 states, Journal of the American College of Surgeons, Volume 207, Issue 3, Supplement, September 2008, Pages S75

2. Atul Gawande, Two Hundred Years of Surgery, N Engl J Med 2012; 366:1716-1723, May 3, 2012

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In October 2008, at the annual meeting of the American College of Surgeons, a presentation called The number of surgical procedures in an American lifetime in 3 states was given by Dr. Peter Lee and Dr. Atul Gawande.

I have been unable to find an original source, and am relying on Yahoo Voices as a secondary source, which is not optimal.

In a study of the 2002 data from three representative US states, they concluded that an American will have, on average, 9.2 surgeries in his or her 85-year lifespan.

Gawande (who made the original claim in the question, and who was a copresenter on the above paper), was also a coauthor of a similar paper looking at surgery rates across the world. While it doesn't directly answer the question, it offers useful context.

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The claim looks plausible, but it would depend on how you define "operation".

CDC data shows that there were 51.4 million inpatient procedures in 2010. The population of the US was 309 million and life expectancy was 78.11 years. So the average American can expect to have 51.4 / 309 * 78.11 = 13 inpatient procedures in their lifetime.

I don't think there's a clear definition of which inpatient procedures are considered "an operation", but this does at least give a rough idea of how common surgery is.

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  • If we take 'surgery' to mean anything that involves cutting someone open, some of those are now done as outpatient procedures. I don't see anything here to cast doubt on the original figures. – DJClayworth Jun 19 '13 at 15:18
  • @DJ: I think this was just meant as a ballpark figure to show that 7 is a reasonable number. Along without counting "inpatient procedures" rather than surgeries, it also makes the completely invalid assumption that the number of procedures/person/year and the average life expectancy have been constant for the last 80-or-so years. – BlueRaja - Danny Pflughoeft Jun 19 '13 at 15:28
  • @DJClayworth, 20 years ago, my arthroscopic knee surgery was done outpatient, so I would agree that outpatient procedures should certainly not be excluded. – cdkMoose Jun 19 '13 at 17:17
  • The only issue with this type of calculation is that it assumes that surgery is equiprobable to occur at any point in a person's life. If, instead, surgeries are more common at certain ages than others, then the result of this type of analysis will not be very accurate. With that said, it at least suggests that the original claim is within the realm of reason. – ESultanik Jun 19 '13 at 19:15

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