- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States.
- Department of Electrical Engineering and Computer Science, University of California Irvine Medical Center, Irvine, CA, United States.
- Department of Medical Scientist Training Program, University of California Irvine Medical Center, Irvine, CA, United States.
- Department of Biological Chemistry, University of California Irvine Medical Center, Irvine, CA, United States.
- Orthopedic Surgery, University of California Irvine Medical Center, Irvine, CA, United States.
Michael Y. Oh, Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States.
DOI:10.25259/SNI_399_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Sandra Gattas1,2,3, Gianna M. Fote1,3,4, Nolan J. Brown1, Brian V. Lien1, Elliot H. Choi1, Alvin Y. Chan1, Charles D. Rosen5, Michael Y. Oh1. Second opinion in spine surgery: A scoping review. 30-Aug-2021;12:436
How to cite this URL: Sandra Gattas1,2,3, Gianna M. Fote1,3,4, Nolan J. Brown1, Brian V. Lien1, Elliot H. Choi1, Alvin Y. Chan1, Charles D. Rosen5, Michael Y. Oh1. Second opinion in spine surgery: A scoping review. 30-Aug-2021;12:436. Available from: https://surgicalneurologyint.com/surgicalint-articles/11073/
Background: As a growing number of patients seek consultations for increasingly complex and costly spinal surgery, it is of both clinical and economic value to investigate the role for second opinions (SOs). Here, we summarized and focused on the shortcomings of 14 studies regarding the role and value of SOs before proceeding with spine surgery.
Methods: Utilizing PubMed, Google Scholar, and Scopus, we identified 14 studies that met the inclusion criteria that included: English, primary articles, and studies published in the past 20 years.
Results: We identified the following findings regarding SO for spine surgery: (1) about 40.6% of spine consultations are SO cases; (2) 61.3% of those received a discordant SO; (3) 75% of discordant SOs recommended conservative management; and (4) SO discordance applied to a variety of procedures.
Conclusion: The 14 studies reviewed regarding SOs in spine surgery showed that half of the SOs differed from those given in the initial consultation and that SOs in spine surgery can have a substantial impact on patient care. Absent are prospective studies investigating the impact of following a first versus second opinion. These studies are needed to inform the potential benefit of universal implementation of SOs before major spine operations to potentially reduce the frequency and type/extent of surgery.
Keywords: Second opinion, Spine surgery, Discordance rates
Second opinions (SOs) in spine surgery are particularly important as there are tremendous variations regarding indications and types of spinal operations offered/performed.[
PubMed, Google Scholar, and Scopus databases were the search engines utilized to identify 14 peer-reviewed articles on SO before spine surgery; these studies were assessed by two reviewers [
Study inclusion criteria. Process of exclusion and inclusion of studies for the scoping review. Search terms included: “spine surgery” AND “SO,” and “SO programs.” Primary articles/ titles included “spine,” “orthopedic,” “opinion,” text included (“SO,” “surgery,” “operation”) and (“neuro”/“ortho” “spine”). SO: Second opinion.
Evaluation of potential bias
Study descriptors, methodological considerations, and potential sources of bias were noted [
In half of the studies, the SO provider also authored the published work, and in the majority of studies there was the potential for selection bias (i.e., the SO was sought by patients as opposed to systematic recruitment).
The following data were extracted: SO recommendation for no or different surgery, SO surgery practices across spine specialties, discordance rates between first and SO treatment and diagnosis, discordance rates for specific operations, likelihood for surgical recommendation during a first versus SOs, and patient-reported outcomes [
Discordant SO recommendations
Two categories of discordant SO recommendations were reported in five of the studies: (1) surgery was recommended by the first and not the SO, or (2) the type of surgery recommended by the SO was different from the type recommended by the first surgeon [
Frequency of SOs in spine surgery practice
Using pooled data across studies, 40.6% (n = 1020) of spine surgery consultations were for a second opinion [
Discordance rates between first and SOs in spine surgery suggest that SOs provide patients with additional information regarding medical risks and financial costs.
One study reported 59.8% diagnosis discordance in spine surgery for SO[
In another study, concordance was either “confirmed” or “clarified,” possibly deflating discordance values relative to the other studies.[
In all studies, discordance was observed in all surgical categories reported [
Patient reported outcomes after SO
Two studies included patient self-reports of perceived health (74.3% reported improvement and 76.5% rated health as good/very good) [
Approximately half of new visits to spine surgeons (40.6%) are SO consultations. Among those SOs, discordance with first opinion is (59.8%). Many patients seek a SO because they are afraid of having surgery, and the majority of discordant SOs recommend no surgery (75%). SOs, therefore, may inform decisions related to surgical costs and undesirable risks/complications of surgeries.
Factors contributing to discordance rates
Factors contributing to discordance rates would appear to include: variable training between physicians/spine surgeons, the different times elapsed between spine surgical opinions, and the potential changes occurring in the patients’ clinical status between opinions.
In addition, providers of the SO should be separate from those providing the service to avoid any conflict of interest.
This report highlights the discordance rates found regarding spinal surgical recommendations between first and SOs. Prospective studies are needed to objectively investigate the impact of following a first versus a SO since, SOs may reduce the physical and financial costs of spine surgery.
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