Over 1.8 Crore Gallbladder Removals: Is India Over-treating?

Gallbladder removal, or cholecystectomy, is among India's most common surgeries, with an estimated 32 lakh performed in 2022 alone. Projections suggest nearly 1.8 crore people may have undergone this procedure between 2021 and 2025, due to a lack of a comprehensive national surgery registry.

Often, gallstones are found incidentally during check-ups and are asymptomatic. International guidelines recommend observation for such cases, reserving surgery for when stones cause significant pain, inflammation, or other complications. However, hospital practices in India frequently lean towards surgery once gallstones are detected.

The fee-for-service model prevalent in corporate healthcare incentivizes investigations and procedures. Health insurance can further reinforce this by simplifying reimbursement for operations over conservative management, influencing clinical decisions.

While cholecystectomy is a valuable surgery when medically indicated, systemic financial and institutional incentives can lower the threshold for intervention. This can lead to unnecessary treatments without conscious intent to overtreat, as procedures always carry inherent risks.

This pattern of potential over-treatment is not unique to gallbladder removal, appearing in high C-section rates, hysterectomies, angioplasties, and other surgeries. The healthcare sequence has shifted from symptom-driven care to proactive testing of healthy individuals, labeling risk factors as diseases.

India requires 'slow medicine,' prioritizing clinical judgment, patient explanation, and informed consent over rapid intervention. This approach involves proceeding deliberately when evidence supports observation and asking crucial questions about the outcomes of inaction.

Better data collection on elective operations, smarter insurance design, and robust primary care are essential to curb unnecessary procedures. A mature health system must value restraint and wisdom in knowing when not to intervene, alongside the capability to perform necessary procedures.