[Limited Data for Second Opinion Programs: a Systematic Review]

Objective: According to a new legislation that will be set up in 2016, patients with an indication for elective surgery have the right to obtain a second opinion. The Federal Joint Committee has to provide a list of indications where this legislation will come into effect. The aim of this systematic review is to summarize available data on second opinion programs and to analyze the indications that should be covered by the new legislation. Methods: Medline, Embase, Proquest and Google scholar were searched for relevant studies in March 2015. To be included, primary studies had to deal with a surgical, orthopedic or gynecological elective procedure, and report agreement between first and second opinion. Study selection and critical appraisal were carried out by 2 reviewers independently. Disagreements were resolved by discussion. Data were extracted and analyzed. Results: In total, 17 studies fulfilled all inclusion criteria. All but one study were from the United States and only 3 studies have been published since 2000. The majority of studies were published in the 70 s and 80 s. Overall, agreement rates varied substantially from 43.0% to 95.5%. Most studies dealt with hysterectomy (n=6), cholecystectomy (n=5) and knee surgery (n=5). Median agreement rates for these procedures were 77.9% (range: 72.7-92.0%), 92.0% (88.2-95.5%) and 85.6% (76.1-93.5%), respectively, in obligatory second opinion programs and 63.0% (58.0-66.7%) and 87.0% (78.0-87.9%) in voluntary second opinion programs. Not enough data were available for knee surgery. Conclusions: Current data on second opinion programs is very limited. There is no data for Germany. Following this, it remains unclear which data or evidence will be used by the Federal Joint Committee to set up the new legislation. However, the findings suggest a potential for second opinion programs. They should be investigated in controlled trials in future.