EACH YEAR, according to the World Health Organisation, over 300m operations are conducted worldwide. Patients in the rich world are more likely to go under the knife(接受手术)—about 60% of people in England are expected to undergo surgery at least once in their lifetime. Some of these procedures are clearly life-saving, such as organ transplants and emergency Caesarean(剖宫产)s. But as the number of other operations continues to grow, some in the field are starting to ask an awkward question: how many are really necessary?(但随着其他手术数量持续增长，业内一些人开始提出一个令人尴尬的问题：究竟有多少手术是真正必要的？)
据世界卫生组织统计，全球每年实施的手术超过3亿台。富裕国家的患者更有可能接受手术——英格兰约60%的人一生中至少会经历一次手术。其中一些手术显然能挽救生命，比如器官移植和紧急剖宫产。但随着其他手术数量持续增长，业内一些人开始提出一个令人尴尬的问题：究竟有多少手术是真正必要的？
Answers have long been hard to come by(难以获得), in part because few randomised controlled trials(随机对照试验) (RCTs), the gold-standard(黄金标准) type of research used to assess medications, were conducted on surgical procedures. That made it difficult to know if patients got better more often with surgery than they might have without.(这使得人们难以判断，接受手术的患者是否比不接受手术时更常康复。) This is now changing. The number of surgical RCTs funded by Britain's National Institute for Health and Care Research(英国国家卫生与护理研究所) increased from 34 in 2011 to 188 in 2023, and national surgical-trials programmes are active across Europe as well as in Australia and Canada.
长期以来，答案一直难以获得，部分原因是针对外科手术开展的随机对照试验（RCT）——评估药物时采用的黄金标准研究方法——少之又少。这使得人们难以判断，接受手术的患者是否比不接受手术时更常康复。如今情况正在改变。英国国家卫生与护理研究所资助的外科RCT数量从2011年的34项增至2023年的188项，欧洲各国以及澳大利亚和加拿大也都在积极开展全国性外科试验项目。
The results are upending(颠覆) the field. Removing an inflamed appendix, an operation that around 5-10% of people have had at some point in their life, has turned out to be no better for most patients than a course of antibiotics.(切除发炎阑尾——约5%至10%的人一生中某个阶段做过的手术——对大多数患者而言，效果并不比一个疗程的抗生素更好。) Trials comparing different surgical techniques have also revealed that cheaper and less complex operations can be more effective. Most striking, the data show that some widely used surgical procedures, such as spinal fusions and rotator-cuff repairs, have effects indistinguishable from placebo or non-surgical care such as physiotherapy.(最令人震惊的是，数据显示一些广泛使用的手术，如脊柱融合术和肩袖修复术，其效果与安慰剂或物理治疗等非手术疗法难以区分。)
这些结果正在颠覆整个领域。切除发炎阑尾——约5%至10%的人一生中某个阶段做过的手术——对大多数患者而言，效果并不比一个疗程的抗生素更好。比较不同手术技术的试验还揭示，更便宜、更简单的手术可能更有效。最令人震惊的是，数据显示一些广泛使用的手术，如脊柱融合术和肩袖修复术，其效果与安慰剂或物理治疗等非手术疗法难以区分。
Operating theatre
手术室