You leave the consultation with a report in hand and a phrase that sounds almost like an excuse: "for now, surgery isn't necessary". The first thing you think is that you are being put on hold, that it is an elegant way of saying they will call you later. But no. In orthopaedics, deciding not to operate is often as clinical and studied as deciding to do so. This article explains the real criteria behind that decision, what the waiting data in Catalonia says, and what rights the patient has when leaving the consultation with more questions than answers.
How long is the actual wait in Catalonia
Before delving into the clinical criteria, it is worth putting the numbers on the table, as they explain why so many people seek a second opinion.
According to data from CatSalut analysed by ACN as of December 2025, there were 209,986 people awaiting surgery, with an average wait of 142 days (compared to 143 in December 2024). Additionally, there were 195,181 people on the list for a diagnostic test (2.5% less than the previous year) and around half a million waiting for an outpatient consultation with a specialist. In total, 914,769 people were on one of the three lists, the second highest figure recorded in a December since Salut started publishing this data back in 2016.
The annual report from the Metges de Catalunya union, presented in May 2026 with data from December 2025, adds a nuance that is particularly relevant here: orthopaedics is the specialty with the longest wait for a first visit, averaging 188 days, ahead of urology (167) and otorhinolaryngology (143). In the Penedès health region, for example, the average wait was 183 days for a knee prosthesis, 170 for a hip prosthesis, and 96 for cataracts. And although waiting times for prosthetics improved slightly, the number of people on the list grew: 1.3% for knees and 7.8% for hips.
With these numbers on the table, it is entirely reasonable to interpret a "we're not operating" as a way to buy time. The rest of this article explains why, in most cases, it is not.
What the law guarantees and what it does not
Here, there is a distinction that almost nobody knows about and that significantly changes the interpretation of everything above: a guaranteed maximum time is not the same as a reference period.
Guaranteed by law are oncological interventions (45 days, 60 in the case of bladder and prostate), cardiac surgery (90 days), and three very specific orthopaedic procedures: cataracts, knee prosthesis, and hip prosthesis, with a maximum of 180 days. If that period is exceeded, the administration is obliged to offer another centre to carry out the intervention.
The rest of the procedures are governed by the maximum reference periods set by Ordre SLT/102/2015: 90 days if the priority is preferred, 180 if it is medium, and 365 if it is low, according to the clinical criteria of each case. The practical difference is enormous: the guaranteed time can be demanded, while the reference time cannot. Any patient can check on La Meva Salut their inclusion date on the list, the expected intervention date, the average wait at their centre, and the guaranteed time that corresponds to them. It is worth checking before assuming that "they will call you later".
The right to request a second opinion
This is probably the most practically useful piece of information in the entire article, and the one that the least number of people know. In Catalonia, the right to a second medical opinion is regulated by Decret 125/2007, of 5 June, and you do not need contacts or luck to access it.
It can be requested in several scenarios: diagnosis of a progressive degenerative disease of the central nervous system without curative treatment, diagnosis of a malignant neoplastic disease (in the case of skin cancers, only if it is melanoma), prescription of a transplant, diagnosis of a rare genetic disease... and, the one that interests us here, prescription of an orthopaedic surgery operation with a risk of significant functional limitation, as well as neurosurgery, cardiac surgery, vascular surgery, or ophthalmic surgery.
The process is simpler than it sounds: it is requested with a form at the citizen attention unit of the centre where the diagnosis was made, or at an official registration unit. Each specialty has at least two centres authorised to issue the report, and it is the centre itself that provides that list; the patient chooses one from it and cannot propose one on their own. If the second centre requires more tests, they are carried out on a priority basis. If that second opinion coincides with the first, treatment continues at the initial centre; if it differs, the patient can choose to stay where they were or move to the centre that issued the new diagnosis.
A right recognised by law, designed precisely for cases like knee or hip surgery, and which is hardly used.
Why sometimes the best decision is not to operate
This is where things get interesting, because we are not talking about medical intuition but rather quite solid evidence.
Arthroscopy in the arthritic knee
A Cochrane review from 2022 on arthroscopic surgery for degenerative knee disease, whether due to osteoarthritis, degenerative meniscus tears, or both, concludes that it can be stated with certainty that arthroscopy does not provide clinically relevant benefits in pain or function. In the same vein, the FIDELITY trial, published in the New England Journal of Medicine, found that in individuals over 35 with degenerative meniscus injury and without real joint blockage, arthroscopic meniscectomy was not superior to supervised physiotherapy in any measured outcome after one year.
Subacromial decompression in the shoulder
A Cochrane review from 2019, with high certainty evidence, concludes that compared to a placebo surgery, subacromial decompression does not improve pain, shoulder function, or quality of life up to a year later. The reference study in this regard is the CSAW trial, published in The Lancet.
What an MRI shows is not always what hurts
A systematic review published in the AJNR journal analysed over 3,100 people without any pain and found disc degeneration in 37% of twenty-somethings and 88% of sixty-somethings. In other words: seeing something "degenerative" in an image does not mean that is what hurts, it is an expected part of aging. For this reason, clinical guidelines such as those from NICE recommend not routinely requesting imaging tests for low back pain unless there are warning signs.
None of this means that operating is unnecessary. In fractures, real mechanical blockages, traumatic tears in young patients, advanced osteoarthritis with indicated prosthetics, or established loss of function, surgery is the right choice and delaying it is detrimental. This is summarised by Dr. Daniel Albareda, a specialist in orthopaedics in Barcelona for many years: the decision to operate or not should always be based on specific clinical criteria, not on whether it is "time" according to the calendar.
What to ask in your next consultation
If you leave a consultation feeling like you have been given the runaround, these five questions can help clarify the situation:
- What happens if I don’t have surgery: will the injury stabilise, improve, or worsen over time?
- What does the surgery offer me compared to waiting and undergoing conservative treatment?
- Does this MRI finding really explain my pain, or is it something typical for my age?
- What should I do in the meantime, and when should we reevaluate my case?
- Does my situation fall within the criteria for requesting a second opinion?
Having these questions noted down does not guarantee that the answer will change, but it does ensure understanding why one decision is made over another. And that, in medicine, is already quite significant.
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