Oftentimes, when evaluating a patient I offer my opinion that they are not a surgical candidate. This opinion comes after a thoughtful review of the history, physical exam, imaging findings and the patient’s expectations. Sometimes, no good surgical options are available.
An important concept to learn is that surgical procedures are focused on decreasing pain and/ or minimizing nerve injury. If a patient has complaints or findings that a surgery cannot improve upon; then the best option is NO surgery.
Another time surgery may not be the best option is when the risks of the procedure outweigh the benefits. Typically, the older or sicker we are the more risk associated with anesthesia and the trauma of surgery. Some procedures may take 2-6 hours (depending on the complexity of the case) which increases blood loss, risk of infection, anesthetic risks and post op complications.
Ultimately, both the surgeon and patient want the best outcome possible. If surgery cannot deliver a reasonable outcome, then non-operative treatment makes the most sense. When I get a disappointed look from the patient during the conversation; I mention that as a surgeon I enjoy operating BUT I appreciate a good outcome even more.