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Second surgical opinion programs: dead or alive?

C K McSherry1, P J Chen, T M Worner

  • 132B-J Health Fund, Professional Service Division, New York Hospital-Cornell Medical Center, New York, USA.

Journal of the American College of Surgeons
|November 14, 1997
PubMed
Summary
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Second surgical opinion programs confirm medical necessity for 91% of elective procedures, demonstrating significant cost-effectiveness. These programs offer benefits beyond cost savings for patients undergoing surgery.

Area of Science:

  • Health Services Research
  • Surgical Outcomes
  • Healthcare Economics

Background:

  • Second surgical opinion programs were initiated in the 1970s to enhance medical care and manage healthcare expenditures.
  • Recent evaluations have raised questions regarding the cost-effectiveness of these programs.

Purpose of the Study:

  • To evaluate the cost-effectiveness and nonconfirmation rates of a second surgical opinion program.
  • To analyze the impact of second surgical opinions on elective procedures and healthcare utilization.

Main Methods:

  • Retrospective review of elective second-opinion surgical consultations (1993-1994) for union members.
  • Analysis of nonconfirmed consultations against subsequent 2-year claims history data.
  • Assessment of nonconfirmation rates by diagnosis and specialty, and calculation of cost-benefit ratio.

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Main Results:

  • 9% of 5,601 consultations (490 cases) were not confirmed as medically necessary.
  • 62% of patients with nonconfirmed opinions did not undergo surgery.
  • Highest nonconfirmation rates were observed in plastic surgery (41%) and gynecology (22%).

Conclusions:

  • Second surgical opinion programs provide cognitive and psychological benefits to patients considering elective surgery.
  • The program demonstrated a cost-benefit ratio of 1.34, indicating financial value.
  • Hysterectomy, prostatectomy, and bunionectomy were among the most frequently nonconfirmed procedures.