First step back to view an entire picture. A surge (lightning used in this example) is an electrical current from an above cloud to earthborne charges some miles distant. What is the path of that current? Maybe three miles down to earth and four miles through earth to those charges. If that current remains outside, then no damage. But when a best connection from cloud to earthed charges is via household appliances, then damage results.
Once that current is permitted inside, it will go hunting for earth via household appliances. If that current is incoming to an adjacent protector, it is also outgoing at the same time through the appliance to earth.
So, a surge current enters the house via an AC hot wire. Incoming to a protector on a black (hot) wire.
Not so. The surge may come from ground just as well, or from a line that isn't providing any power at all. Most I've seen have done their damage through telephone or cable. In fact, "from" and "to" are just conceptual, for our brains' benefits, and are usually backwards. A current loop is formed, and the surge happening means it has already "found" one or more paths. Those paths, if at high voltage, like lightning, can easily jump across insulated conductors, too. It's not bound for just one AC line, though if it hits your stuff, it will be traveling along ground or neutral. The best path to ground might be from your cablemodem's NIC to the cable entering the house, FI, rather than the cable's bonding near the service entrance, due to the inductance of that path, compared to a direct path to ground.
Then many consumers speculate that MOVs are sacrificial.
No, that is fact. When a MOV passes a large current, it degrades. Its electrical characteristics change, and it may get cracks. There is no way for us, or the makers of the SPDs, either, to know before-hand how a specific MOV is going to fail in a specific installation, assuming there are enough surges to cause it to, over time. There is also no assurance than a MOV with a connection between its terminals is going to be effective, if it fails by way of requiring added energy to activate. A MOV that is sized to where it won't degrade much over its service life is going to require powerful lightning strikes to activate, making it basically useless for the rest of the surges, and also only a hope and a prayer, since then the MOV will have to be the best path to ground for the strike, which is not something easily controlled.
But, MOVs like are in your surge protectors can be had for $2 or less in individual quantities, and who knows how cheap in quantities that companies like APC are buying. The protection is good considering the cost, including the now-required thermal protection for the MOV.
Every surge it shunts is one whatever connects to it doesn't have to deal with, most of which are not from lightning. When lightning strikes, all bets are off. The surge strip may protect, which is great if it does, but if it doesn't, oh well. Discharging coils, power grid circuitous re-closing, super-imposed voltage spikes from crappy SMPSes, and small surges from the sorts of conditions that create lightning strikes, are much more what they are there for, to keep your equipment working well and for a long time in normal use. Lightning-born surges may be protected by them, but if so, the surge was already protected against other factors, since working protection means it was fairly low-energy as it traveled through the home (IE, it would quickly have fried itself, and allowed the rest of the energy to go through your devices, otherwise). They may be able to protect against lightning-born surges sometimes, but that's just a nice extra when it happens. In general, you can't do much against Thor, once the building is up and wiring in place.
Verses proven technolgy that, at 50,000 amps, will make 20,000 amp lightning irrelevant.
Anything that can take 20,000 amps is likely not connected to any electrical system in your home. Most electronics will be burning up their wiring well before 100 amps. If that kind of current is being carried, things will burn, and fire will be a much greater danger than loss of some electronics.
What does a protector adjacent to an appliance not have? That low impedance (ie 'less than 10 foot') connection to earth.
An appliance doesn't usually have that, either (I've only ever seen that in the case of a washer and dryer in a garage), nor does either have what turns a path from delectable to disgusting: a low-
inductance path to ground. It will take a low-impedance or high-inductance path, and if it's high-frequency, the high-inductance path will win. That path may cross conductors which are air-gapped, and may not be the path of least impedance. Keeping potential paths low-impedance helps prevent your wiring from being a good target, but once that's out of the way...