Observational studyBMC musculoskeletal disorders2017
Second opinion for degenerative spinal conditions: an option or a necessity? A prospective observational study.
Observational study in BMC musculoskeletal disorders, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 62 citations in OpenAlex.
- Cost-effectiveness of a second opinion program on spine surgeries: an economic analysis.BMC health services research · 2023Article
- Does the second opinion directive in Germany reach the patient? A parallel-convergent mixed-methods study.BMC health services research · 2023Article
- Impact of a quality programme on overindication of surgeries for endometriosis and cholecystectomies.BMJ open quality · 2023Article
- [Second opinion on spine surgery : Indication rarely confirmed and conservative treatment options are worthwhile].Schmerz (Berlin, Germany) · 2023Article
- Using general practitioners with an extended role in spinal practice for the initial assessment of patients referred to spinal surgeons: preliminary experience and challenges.Primary health care research & development · 2023Review
- Unnecessary spine surgery: can we solve this ongoing conundrum?Frontiers in surgery · 2023Article
- Second opinions for spinal surgery: a scoping review.BMC health services research · 2022Article
- Attitude toward second opinions in Germany - a survey of the general population.BMC health services research · 2022Article
- Clinical outcome analysis in surgical patients enrolled in a Second Opinion Program in spine surgery.Einstein (Sao Paulo, Brazil) · 2022Observational
- Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion.BMC health services research · 2021Observational
- Analysis of second opinion programs provided by German statutory and private health insurance - a survey of statutory and private health insurers.BMC health services research · 2021Article
- Second opinion in spine surgery: A scoping review.Surgical neurology international · 2021Article
- Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion.BMC health services research · 2020Article
- Outcomes of second opinions in general internal medicine.PloS one · 2020Article
- Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study.BMJ open · 2019Observational
- Obtaining a second opinion is a neglected source of health care inequalities.Israel journal of health policy research · 2019Article
- Second opinion programs in spine surgeries: an attempt to reduce unnecessary care for low back pain patients.Brazilian journal of physical therapyArticle
- Tackling low back pain in Brazil: a wake-up call.Brazilian journal of physical therapyReview
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSecond opinions may improve quality of patient care. The primary objective of this study was to determine the concordance between first and second diagnoses and opinions regarding need for spinal surgery among patients with back or neck pain that have been recommended spinal surgery.
methodsWe performed a prospective observational study of patients who had been recommended for spinal surgery and received a second opinion between May 2011 and May 2012 at the Hospital Israelita Albert Einstein on the advice of their health insurance company. A physiatrist and orthopaedic surgeon independently performed the second assessment. If both agreed surgery was indicated, or consensus could not be reached, participants attended a spine review panel for a final recommendation. Descriptive analyses compared diagnoses and management plans of the first and second opinions.
resultsOf 544 referred patients, 16 (2.9%) did not meet inclusion criteria, 43 (7.9%) refused participation and 485 were included. Diagnoses differed from the first opinion for 290 (59.8%). Diagnoses of cervical and lumbar radiculopathy were concordant in 36/99 (36.4%) and 116/234 (49.6%) respectively. The second opinion was for conservative treatment for 168 (34.6%) participants, 27 (5.6%) were not considered to have a spine condition, and 290 (59.8%) were referred to the review board. 60 participants did not attend the board review and therefore did not receive a final recommendation. Board review was conservative treatment for an additional 67 participants, 20 were not considered to have a spine condition and 143 participants were recommended surgery. Overall, 33.6% received a final opinion of surgery (143/425) although only 66 (15.5%) received the same surgical recommendation, 235 (55.3%) were advised to have conservative treatment, and 47 (11.1%) were not considered to have a spinal diagnosis.
conclusionsWe found a large discordance between first and second opinions regarding diagnosis and need for spinal surgery. This suggests that obtaining a second opinion could reduce potentially unnecessary surgery.
trial registrationCurrent Controlled Trials ISRCTN07143259 . Registered 21 November 2011.
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