Gattas Sandra, Fote Gianna M, Brown Nolan J, Lien Brian V, Choi Elliot H, Chan Alvin Y, Rosen Charles D, Oh Michael Y
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.
Surg Neurol Int. 2021 Aug 30;12:436. doi: 10.25259/SNI_399_2021. eCollection 2021.
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.
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.
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.
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.
随着越来越多的患者因日益复杂且昂贵的脊柱手术前来咨询，研究二次诊断（SO）的作用具有临床和经济价值。在此，在进行脊柱手术之前，我们总结并聚焦了14项关于二次诊断的作用和价值研究的不足之处。
利用PubMed、谷歌学术和Scopus，我们确定了14项符合纳入标准的研究，这些标准包括：英文、原始文章以及过去20年发表的研究。
我们确定了以下关于脊柱手术二次诊断的结果：（1）约40.6%的脊柱咨询为二次诊断病例；（2）其中61.3%收到了不一致的二次诊断；（3）75%的不一致二次诊断建议采取保守治疗；（4）二次诊断的不一致适用于多种手术。
关于脊柱手术二次诊断的14项综述研究表明，一半的二次诊断与初次咨询给出的诊断不同，并且脊柱手术的二次诊断会对患者护理产生重大影响。缺乏对遵循初次诊断与二次诊断的影响进行调查的前瞻性研究。需要这些研究来告知在进行重大脊柱手术前普遍实施二次诊断的潜在益处，以可能减少手术的频率和类型/范围。
