Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany.
Kliniken an der Paar, Aichach und Friedberg, Germany.
BMC Musculoskelet Disord. 2021 Jun 28;22(1):595. doi: 10.1186/s12891-021-04465-5.
German social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurances. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty.
The largest statutory health insurance funds in Bavaria offered patients who had been recommended to have knee arthroplasty the opportunity to partake in a second opinion programme which consisted of an in person presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit.
A total of 141 (66%) of 215 patients who presented for a second opinion participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. After receiving the second opinion 28 of 56 (41%) undecided patients preferred knee arthroplasty, 14 no knee arthroplasty, 14 remained undecided. Four of 46 patients with a preference for "arthroplasty" changed their decision to "no arthroplasty", five of 35 patients from "no arthroplasty" to "arthroplasty". The patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). They rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) (best:1; worst:6). Logistic regression analyses showed that the recommendation of the second opinion physician for joint arthroplasty was associated with the guideline criteria radiological severity of osteoarthritis (p = 0.001) and knee-joint-specific quality of life (p = 0.041).
The second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The association of guideline criteria to the second recommendation suggests a high quality of the second opinion. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.
德国社会立法赋予患者在择期手术前获得第二意见的权利，并为法定健康保险的报销定义了质量标准。然而，择期手术前的第二意见的效果在很大程度上是未知的。本研究的目的是评估膝关节置换推荐患者的第二意见计划的效果。
巴伐利亚州最大的法定健康保险基金为被推荐接受膝关节置换术的患者提供了参加第二意见计划的机会，该计划包括向经验丰富的膝关节外科医生进行面对面介绍。在这项队列研究中，从 2016 年 10 月 7 日至 2020 年 2 月 14 日，从参加第二意见计划并签署知情同意书的连续患者中纳入患者。在第二意见就诊前后收集数据。
在 215 名前来接受第二意见的患者中，有 141 名（66%）参加了评估研究。第二意见医生建议 40%的患者进行膝关节置换术，如果病情恶化则建议 40%的患者进行膝关节置换术，20%的患者不进行膝关节置换术。在获得第二意见后，56 名犹豫不决的患者中有 28 名（41%）更倾向于膝关节置换术，14 名不倾向于膝关节置换术，14 名仍犹豫不决。46 名首选“关节置换术”的患者中有 4 名改变了决定为“不进行关节置换术”，35 名首选“不进行关节置换术”的患者中有 5 名改变了决定为“关节置换术”。患者根据决策信心量表（就诊前：5.4±3.0；就诊后：7.8±2.5；p<0.001）对自己的决策更有信心。他们对第二意见计划的满意度平均评分为 1.35（±0.60）（最好：1；最差：6）。逻辑回归分析显示，第二意见医生对关节置换术的建议与骨关节炎的放射学严重程度（p=0.001）和膝关节特异性生活质量（p=0.041）的指南标准相关。
经验丰富的膝关节外科医生的第二意见经常与最初的膝关节置换建议不同。指南标准与第二建议的相关性表明第二意见的质量很高。从患者的角度来看，第二意见减少了他们治疗决策的不确定性。
