Second opinion in spine surgery: A scoping review

Gattas, Sandra; Fote, Gianna M.; Brown, Nolan J.; Lien, Brian V.; Choi, Elliot H.; Chan, Alvin Y.; Rosen, Charles D.; Oh, Michael

doi:10.25259/sni_399_2021

Cited by 6 publications

(8 citation statements)

References 18 publications

(25 reference statements)

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“…There is a lack of clearly de ned reasons that can explain the discrepancy among surgical indications to treat degenerative neck or low back diseases [31,32]. Some authors imply that different factors contribute to the increased frequency of complex surgery indications.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients were initially evaluated by surgical specialists, neurosurgeons and orthopedists, who generally tend to provide more surgical care [44] which, by nature, is more expensive and only after a few weeks patients were evaluated by the second opinion program. This leads to the conclusion that the timing of medical evaluation may also explain the discrepancy in medical decision, considering that the degenerative aspect of the diseases, patient complaints and severity of symptoms could have been different from the rst opinion [31,32].…”

Section: Discussionmentioning

confidence: 99%

“…Second opinions for spine surgery have been considered as a potential strategy to improve surgical decision making and patient outcomes [28,30]. The topic is relevant, and two scoping reviews on second opinion for spine surgery has recently been published, investigating the frequency and impact of second opinions between studies [31] and, comparing the concordance rates in diagnoses and type of surgery, number of surgeries, patient-reported outcomes, costs, and health care use associated with second opinion programs [32]. These reviews concluded that there is a need study comparing clinical outcomes between those who received versus did not receive a second opinion and this potential for improving surgical decision-making, nancial costs of spine surgery and patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of a second opinion program on spine surgeries: an economic analysis

Antonioli

Malheiro

Teich

et al. 2023

Preprint

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Background In this study we proposed a new strategy to measure cost-effectiveness of second opinion program on spine surgery, using as measure of effectiveness the minimal important change (MIC) in the quality of life reported by patients, including the satisfaction questionnaire regarding the treatment and direct medical costs.Methods Retrospective analysis of patients with prior indication for spine surgery included in a second opinion program during May 2011 to May 2019. Treatment costs and outcomes where compared considering each patients’ recommended treatment before and after the second opinion. Costs were measured under the perspective of the hospital, including hospital stay, surgical room, physician and staff fees and other costs related to hospitalization when surgery was performed and physiotherapy or infiltration costs when a conservative treatment was recommended. Reoperation costs were also included. For comparison analysis, we used data based on our clinical practice, using data from patients who underwent the same type of surgical procedure as indicated by the first referral. The measure of effectiveness was the percentage of patients who achieved the MIC in quality of life measured by the EQ-5D-3L 2 years after starting treatment. An incremental cost-effectiveness ratio (ICER) was calculated.Results Based upon the assessment of 1,088 patients that completed the entire second opinion process, conservative management was recommended for 662 (60.8%) patients; 49 (4.5%) were recommended to infiltration and 377 (34.7%) to surgery. Complex spine surgery, as arthrodesis, was recommended by second opinion in only 3.7% of cases. The program resulted in financial savings of -$6,705 per patient associated with appropriate treatment indication, with an incremental effectiveness of 0.077 patients achieving MIC when compared to the first referral, resulting in an ICER of $-87,066 per additional patient achieving the MIC, ranging between $-273,016 and $-41,832.Conclusion After 2 years of treatment, the second opinion program demonstrated the potential for cost-offsets associated with improved quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of a second opinion program on spine surgeries: an economic analysis

Antonioli

Malheiro

Teich

et al. 2023

Preprint

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“…A scoping review investigating the frequency and impact of second opinions has recently been published [ 14 ]. Our review provided a more comprehensive assessment of the current evidence on second opinions.…”

Section: Discussionmentioning

confidence: 99%

“…spinal fusion) [ 13 ]. Some studies have reported outcomes of second opinions for people with back pain, including a recent scoping review [ 14 ]. However this scoping review only investigated a limited number of outcomes, namely the frequency of second opinions and the discordance between first and second opinions.…”

Section: Introductionmentioning

confidence: 99%

Second opinions for spinal surgery: a scoping review

Ferreira

Zadro

Liu

et al. 2022

BMC Health Serv Res

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Background Second opinions have the goal of clarifying uncertainties around diagnosis or management, particularly when healthcare decisions are complex, unpleasant, and carry considerable risks. Second opinions might be particularly useful for people recommended surgery for their back pain as surgery has at best a limited role in the management of back pain. Methods We conducted a scoping review. Two independent researchers screened PubMed, EMBASE, Cochrane CENTRAL and CINAHL from inception to May 6th, 2021. Studies of any design published in any language were eligible provided they described a second opinion intervention for people with spinal pain (low back or neck pain with or without radicular pain) either considering surgery or to whom surgery had been recommended. We assessed the methodological quality with the Downs & Black scale. Outcomes were: i) characteristics of second opinion services for people considering or who have been recommended spinal surgery, ii) agreement between first and second opinions in terms of diagnoses, need for surgery and type of surgery, iii) whether they reduce surgery and improve patient outcomes; and iv) the costs and healthcare use associated with these services. Outcomes were presented descriptively. Results We screened 6341 records, read 27 full-texts, and included 12 studies (all observational; 11 had poor methodological quality; one had fair). Studies described patient, doctor, and insurance-initiated second opinion services. Diagnostic agreement between first and second opinions varied from 53 to 96%. Agreement for need for surgery between first and second opinions ranged from 0 to 83%. Second opinion services may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. Second opinion services may reduce costs and healthcare use (e.g. imaging), but might increase others (e.g. injections). Conclusions Second opinion services typically recommend less surgical treatments compared to first opinions and may reduce surgery rates in the short-term, but it is unclear whether these reductions are sustained in the long-term or if patients only delay surgery. There is a need for high-quality randomised trials to determine the value of second opinion services for reducing spinal surgery.

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