Results of a Second-Opinion Program for Coronary Artery Bypass Graft Surgery

Abstract

Second opinions for surgical procedures are now being sought by patients or are required by insurance carriers. We examined outcomes among 88 patients (76 men; average age, 59 years) referred for a second opinion as to the need for coronary artery bypass graft surgery. All patients had undergone coronary arteriography, which disclosed in 63 (72%) multivessel coronary artery disease, while in the remaining 25 patients single-vessel disease involved the left anterior descending coronary artery. Continuation of medical therapy was recommended for 74 (84%) of the 88 patients. Sixty of these 74 patients chose this option and continued to receive medical therapy without any fatalities during a follow-up period of 27.8 months. The remaining 14 patients elected to cross over to surgical therapy at an average of 11.3 months from the second opinion. We conclude that second opinions for selected, motivated patients slated for coronary artery bypass graft operation afford a significant and safe option. Moreover, a majority of patients will adhere to a second opinion recommending medical therapy, thus reducing the need for surgical intervention by as much as 50%. Since the study was based on a small sample size of self-selected patients, these data require caution in extrapolating to the general population with coronary artery disease.

Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel

“…SOs are hence common in orthopedics [ 18 , 44 ] and general surgery [ 17 ]. Patients tended to adhere to a SO recommending non-invasive therapy rather than surgery, thus SOs can reduce surgery by 50% [ 23 ]. Another notable finding is that 3% of the respondents sought a SO from an oncologist, a fairly high rate, relative to the proportion of cancer in the Israeli population (1.6%) [ 47 ].…”

“…Financially, the aim of mandatory SO programs was based on the premise that they can reduce costs of unnecessary, expensive and invasive diagnostic and surgical procedures and save rehabilitation costs [ 8 , 9 , 21 , 22 ]. Moreover, patients tend to adhere to a SO recommending non-invasive therapy rather than surgery, thus SOs can reduce the need for surgery by 50% and save costs [ 23 ]. Yet, in practice, many SOs are not part of organized programs and so, there is no organized mechanism.…”

Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease

“…The likely costs of our program are much less than those of the Diabetes Prevention Program (50) and Look Ahead (which relies on highly trained leaders and medications; see (51)). The costs are also vastly lower than coronary bypass surgery, which consumes more health dollars than any other medical procedure in the U.S. (52).…”

Physicians’ Perspectives on the Implementation of the Second Opinion Directive in Germany—An Exploratory Sequential Mixed-Methods Study

“…This trend is in accordance with growing needs for knowledge as ever more patients are actively seeking information about their disease and treatment options, and are also searching for a second opinion [ 1 ]. Certainly, second opinions can support patients in their decision-making process in the face of uncertainty [ 2 , 3 ], which may help to avoid unnecessary medical testing and/or interventions [ 4 ]. The German health care system accommodates various forms of second opinions, which are summarized in Figure 1 .…”