Quinn Patrick L, Nikahd Melica, Saiyed Shah, Heifetz Addie, Bath Natalie M, Hyer J Madison, Cloyd Jordan M, Jain Shikha, Ejaz Aslam
From the Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (Quinn, Nikahd, Bath, Hyer, Cloyd).
University College Dublin, Dublin, Ireland (Saiyed).
J Am Coll Surg. 2025 Mar 1;240(3):270-278. doi: 10.1097/XCS.0000000000001213. Epub 2025 Feb 14.
Due to the complexity of pancreatic surgery, patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) may seek out the opinion of more than 1 surgeon. Little is known regarding how second surgical opinions impact the likelihood of pancreatectomy and perioperative outcomes. Our study aimed to determine the impact of obtaining second surgical opinions on pancreatectomy rates and to assess its impact on surgical outcomes.
Patients who were diagnosed with PDAC between 2013 and 2020 were identified using 100% Medicare Inpatient and Outpatient Standard Analytic Files. Data collected included the number of surgeons consulted and geographic region. Receipt of pancreatectomy and perioperative outcomes were compared between patients who received only 1 and more than 1 surgical consultation.
Of 116,072 patients diagnosed with PDAC, 10,640 (9.2%) underwent pancreatectomy. A total of 4,913 (4.2%) patients received a second surgical opinion, of whom 1,906 (17.9%) patients underwent pancreatectomy after the second opinion visit. Patients receiving a second surgical opinion were more likely to undergo pancreatectomy (adjusted odds ratio 6.17; 95% CI 5.78 to 6.59). Patients who received a second opinion and underwent surgery had equivalent length of stay and complication rates compared to those who underwent surgery without seeking a second opinion (both p > 0.05).
Among Medicare patients who underwent pancreatectomy for pancreatic cancer, approximately 1 in 7 patients received a second surgical opinion. Further research is needed to determine how patient motivations, referral patterns, disease characteristics, and treatments all interplay to affect clinical outcomes for patients undergoing pancreatectomy for PDAC.
由于胰腺手术的复杂性，被诊断为胰腺导管腺癌（PDAC）的患者可能会寻求不止一位外科医生的意见。关于第二种手术意见如何影响胰腺切除术的可能性和围手术期结果，目前知之甚少。我们的研究旨在确定获得第二种手术意见对胰腺切除率的影响，并评估其对手术结果的影响。
使用100%的医疗保险住院和门诊标准分析文件，确定2013年至2020年间被诊断为PDAC的患者。收集的数据包括咨询的外科医生数量和地理区域。比较仅接受一次手术咨询和接受不止一次手术咨询的患者的胰腺切除术接受情况和围手术期结果。
在116,072例被诊断为PDAC的患者中，10,640例（9.2%）接受了胰腺切除术。共有4,913例（4.2%）患者获得了第二种手术意见，其中1,906例（17.9%）患者在第二次意见就诊后接受了胰腺切除术。接受第二种手术意见的患者更有可能接受胰腺切除术（调整后的优势比为6.17；95%置信区间为5.78至6.59）。与未寻求第二种意见而接受手术的患者相比，接受第二种意见并接受手术的患者住院时间和并发症发生率相当（两者p>0.05）。
在因胰腺癌接受胰腺切除术的医疗保险患者中，约七分之一的患者获得了第二种手术意见。需要进一步研究以确定患者动机、转诊模式、疾病特征和治疗如何相互作用，从而影响因PDAC接受胰腺切除术的患者的临床结果。
