Aims: The aims of this scoping review are to describe: (i) the characteristics of second opinion services for spinal surgery; (ii) diagnostic agreement between first and second opinions; (iii) agreement in treatment recommendations between first and second opinions; (iv) the results of second opinion services for reducing rates of surgery and improving patient-reported outcomes; and (v) the costs and healthcare use associated with second opinion services
Methods: Two independent researchers screened three electronic databases (Pubmed, EMBASE and Cochrane CENTRAL) from their inception to May 6th, 2021. Studies of any design were eligible provided that 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 studies' methodological quality with the Downs & Black scale. Outcomes were: i) characteristics of second opinion services, ii) agreement between first and second opinions in terms of diagnoses, need for surgery and type of surgery, iii) their effectiveness in reducing surgery rates and improving patient –reported outcomes; and iv) the costs and healthcare use associated with these services. Outcomes were presented descriptively
Results: We included 12 studies (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% across studies. Agreement for need for surgery between first and second opinions ranged from 0% to 83%. There is some very-low quality evidence that 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 some healthcare use (e.g. imaging), but might increase others (e.g. injections, prescription drugs)
Conclusions: There is a need for high-quality studies to determine the value of second opinion services for reducing spinal surgery.