Outcomes of a medical second opinion programme before knee arthroplasty: A prospective cohort study

Abstract

Background: German social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurance. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty.Methods: The largest statutory health insurance funds in Bavaria offered patients to whom knee arthroplasty was recommended participation in a second opinion programme with personal presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit.Results: A total of 141 (66%) of 215 second opinion patients participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. The frequency of undecided patients decreased from 41% to 12%. After the second opinion, the patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). Logistic regression analyses showed that higher radiological severity of osteoarthritis on the Kellgren/Lawrence scale (p = 0.001) and lower knee-joint-specific quality of life on the KOOS questionnaire (p = 0.041) were associated with the recommendation for knee arthroplasty by the second opinion physician. The patients rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) on a scale from 1 to 5.Conclusion: The second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The results of this study suggest that a second opinion may improve adherence to guidelines for indications of knee arthroplasty. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.