Ask HN: Is there an exhaustive list of surgical procedures? | Hacker News Reader

Ask HN: Is there an exhaustive list of surgical procedures?

20 pointsJabavuAdams22 comments

I've only found small lists of the most common procedures. How do hospitals handle this? I'd like to obtain / compile a list of all surgical procedures as a driver for thinking about / working on semi- then fully-autonomous robotic surgery.

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Interventional radiologist here. The short answer is "no." I personally perform more than 100 different types of procedures, but there are lots of variations of each procedure, and different techniques for performing the same procedure. (And you need to know what to do when something unexpected happens in the middle of a procedure)

There are thousands of CPT codes, and even more procedures, since one CPT code could describe multiple different procedures, and some procedures involve combining multiple CPT codes. There is no formal approval process for new surgical procedures, and there is no comprehensive list. New procedures are invented all the time.

Your best bet is to pick a specific area, then find a surgeon to shadow. A lot of details of surgical techniques are not written down anywhere, and you learn by working with other surgeons. There are a few books that go through the basic procedural details. For example, Zollinger's "Atlas of surgical operations" is a good reference for abdominal surgery, and Kandarpa's "Handbook of interventional radiologic procedures" is a good reference for interventional radiology procedures. "Biodesign" by Zenios is a good introduction to inventing new medical devices.

How can there be no formal approval process for surgical procedures? This drives me crazy. Surgical procedures should have a high evidence standard just like drugs. Otherwise how can a patient be confident in the science?

My father was a neurosurgeon. Sorry to burst your bubble, but when you go to someone like him, it is not called medical science. It is medical practice.

The medical industry does not provide the information required to be confident in your personal outcome. At best they can provide statistics about populations. On an individual basis, it is an absolute crap shoot.

I think you can relax - because there is a very high evidence standard in surgery. It’s just not regulated in that traditional sense because there are way too many variations and caveats to everything. There are a million niches and each one is occupied by a tiny group of specialists who know everything about theirs. I know this because I’ve been to their conferences and they invest a lot of energy into collecting statistics, verifying hypotheses, trying out subtle improvements etc. And then they argue for ever and ever about which approach delivers an ever so slight advantage or improvement.

There was a study out of the UK on here recently that seems to indicate most Orthopedic surgeries are worse than no surgery. So I'm very not relaxed :)

I don’t think orthopedic surgery is a very good representative for all surgery ;)

Thanks, I did have the sense that it would be impossible to formalize all the variations. So, perhaps I should not have written "exhaustive". I just would like something more complete than my initial searches revealed.

I think that, yes, eventually we will need to have the robot surgeons watch operations and listen to / question human surgeons. The problem is that we're not really able to have a robust teaching / learning conversation and show/tell with and AI yet.

It sounds to me like you'll want to find procedure codes. Per https://www.aapc.com/resources/medical-coding/cpt.aspx, you'll want to look for CPT codes in the range of 10021–69990. The linked site has lists, but might not have the details you want, so you'll have to do your own research.

Best of luck!

Thanks!

I am no expert on this but can hopefully point you in the right direction based on what I learned recently (here on hn!)

Assuming you are in the USA- they just passed a law where all hospitals will need to publicly publish the list of all the procedures they do and the cost. Until now this,as I understand this was guarded very tightly and the common person would never get it. This information is maintained in what is called a “chargemaster” (charge description master). So I am thinking you can possibly download a few chargemasters abd then process it via queries etc and get a longer list of procedures. Hopefully this set you in the right direction.

I'm in Canada, but this is quite helpful, nonetheless. Thanks!

Not an incredible help, but I’m Canadian and married to a vascular surgeon. I have never seen a public list but their procedural billings go through a web application of some sort to the Ministry of Health (Ontario). I do know that the process is somewhat composed because there are elements that make for longer or more complicated variations of any given procedure. The Ministry of Health of whatever province you’re in may be a help.

Holy crap really? Whats the name of this law?

Sorry not sure about the name of the law. But I learned what I indicated on HN. I would search on HN for the word “charge master” or “chargemaster” and see you can see the hits. I think I learned about this in the last 2 months (90% confidence) so to be safe May be narrow your search to last 6months. The word is quite unique so there shouldn’t be too many hits to sift through.

Also looked like hn user aurizon posted google and npr links a few comments below about how this law is being fought.

Search “hospital price transparency law”. For example:

https://www.cms.gov/hospital-price-transparency

For eg here is Stanford healthcare’s charge master in json

https://stanfordhealthcare.org/content/dam/SHC/patientsandvi...

I work on educational devices/content for laparoscopic procedures. It looks like we’re going into robotic as well. I find that this kind of information can be quite tricky to extract from the internet.

But just out of curiosity, could you tell more about what you’re up to slash what you’re thinking about?

Just taking notes, for now. Might try to incorporate what I learn into a simulation/game/work of fiction. Looking forward to having the sci-fi auto-surgeon.

In the U.S. you can parse through the Open Datasets from CMS at https://www.cms.gov

I'd like to see the price ranges for each as well.

The insurers and hospital admins have been hiding this data for years and are fighting and lobbying against this secret data. Recent laws have changed what they must reveal - they fight on regardless.

https://www.google.com/search?q=Trump+administration+price+t...

https://www.npr.org/sections/health-shots/2021/07/02/1012317...

https://www.npr.org/sections/health-shots/2021/10/14/1045828...

Eg. Here is Stanford’s. https://stanfordhealthcare.org/content/dam/SHC/patientsandvi...

I would just google the hospital name and and the word chargemaster next to it.

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