Second Opinions before Surgery Have the Potential to Reduce Costs - An Exploratory Analysis. / Zweitmeinungen vor operativen Eingriffen haben das Potenzial, Kosten zu senken ­ eine explorative Analyse.

AIM: In this study cost data of patient's first and second opinion of a German second opinion program of patients with orthopedic indications are raised and compared. METHODS: Anonymized patient data were used from a second opinion program gathered in the period from 2013 to 2015. Costs of the first and second opinion were raised using DRG, the EBM catalog, the remuneration agreement on physical therapy and the price of drugs. In order to increase transferability, initial therapy recommendation and second opinion were compared in a cost analysis to determine a theoretical savings potential. RESULTS: A total of 170 consecutive patients with orthopedic indication and first and second opinion were analyzed in this study. Only one out of three initial therapy recommendations was confirmed by the second opinion. In the second opinion, physiotherapy and pain therapy were often suggested for indications which received a surgery referral by the initial therapy recommendation. In scenario 1 (average resource use), the costs of the first therapy recommendation in median was 5020.96 € (IQR = 961.71 - 7342.66), the second opinion was 322.07 € (IQR = 146.39 - 1341.32). In median, the operation costs of the initial therapy recommendation were equal to 156.12 physiotherapeutic sessions and 26.02 N3 packs Ibuprofen 800. CONCLUSION: Therapy costs for the initial therapy recommendation are clearly exceeding the therapy costs of the second opinion. This assumes a potential to reduce therapy costs with the use of a second opinion. This study lays the foundation to carry out further conclusive analyses concerning this matter.

Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion.

BACKGROUND: As of 2015, second opinions are legally implemented in Germany. However, empirical results from German second opinion programs are lacking. The aim of this study was to examine several aspects within a population of a German second opinion program. METHODS: Study population consisted of patients who sought a second opinion in the period from August 2011 to December 2016. Multivariate logistic regression and ANOVA were used to examine differences in patient characteristics, differentiated by agreement of initial therapy recommendation and second opinion. Follow-up points for patient satisfaction and HRQoL were defined at 1, 3 and 6 months after obtaining the second opinion. RESULTS: Total number of patients who sought a second opinion was 1414. Most common indications concerned the knee (37.3%), spine (27.3%), hip (11.5%) and shoulder (10.1%). The independent specialists did not confirm the initial therapy recommendations in two out of three cases. The type of indication influenced the agreement between initial therapy recommendation and the second opinion significantly (p = 0.035). The second opinion and the offered service was highly valued by the patients (89%). CONCLUSIONS: The second opinion offers patients the possibility to confirm a medical indication independently and support patients in their decision making process. Reasons for the large discrepancy between initial therapy recommendation and second opinion should be addressed in future research.

[First results of a German second opinion program show high patient satisfaction and large discrepancies between initial therapy recommendations and second opinion]. / Erste Ergebnisse eines deutschen Zweitmeinungsportals zeigen neben einer hohen Patientenzufriedenheit große Diskrepanzen zwischen Erstempfehlung und Zweitmeinung.

BACKGROUND AND OBJECTIVES: Although legally anchored, there are no empirical results from German second opinion programs. In this study, various aspects within a population of a second opinion program are examined. METHODS: In this study patients were analyzed who sought a second opinion in the period from August 2011 to December 2016. Differences in patient characteristics, differentiated by agreement of first and second opinion, were analyzed using multivariate logistic regression. Patients' satisfaction and quality of life were examined one, three and six months after obtaining the second opinion. RESULTS: In total, 1,414 patients sought a second opinion. Most frequently, second opinions were sought on knee (38.7 %), back (26.8 %), hip (11.7 %), and shoulder (10.2 %) complaints. Except for the indication (p=0.035), no patient characteristic had influence on the conformation of the second opinion. Approximately two out of three initial recommendations were not confirmed by the specialists. 89 % of the patients were satisfied or very satisfied with the second opinion and the service offered. CONCLUSIONS: The second opinion offers patients the opportunity to seek an additional independent medical opinion and thus provides support for decision making. Further research is needed to examine the reasons for the high discrepancies between the first and second opinions.

Nine genetic polymorphisms associated with power athlete status - A Meta-Analysis.

OBJECTIVES: In this study the association between genetic polymorphisms and power athlete status with possible interference by race and sex was investigated to identify genetic variants favourable for becoming a power athlete. DESIGN: This meta-analysis included both, case-control and Cohort studies. METHODS: Databases of PubMed and Web of Science were searched for studies reporting on genetic polymorphisms associated with the status of being a power athlete. Thirty-five articles published between 2008 and 2016 were identified as eligible including a total number of 5834 power athletes and 14,018 controls. A series of meta-analyses were conducted for each of the identified genetic polymorphisms associated with power athlete status. Odds ratios (ORs) based on the allele and genotype frequency with corresponding 95% confidence intervals (95%CI) were calculated per genetic variant. Heterogeneity of the studies was addressed by Chi-square based Q-statistics at 5% significance level and a fixed or random effects model was used in absence or presence of heterogeneity respectively. Stratified analyses were conducted by race and sex to explore potential sources of heterogeneity. RESULTS: Significant associations were found for the genetic polymorphisms in the ACE (rs4363, rs1799752), ACTN3 (rs1815739), AGT (rs699), IL6-174 (rs1800795), MnSOD (rs1799725), NOS3 (rs1799983, rs2070744) and SOD2 (rs4880) genes. CONCLUSIONS: Nine genetic polymorphisms have been identified in the meta-analyses to have a significant association with the status of being a power athlete. Nevertheless, more research on the investigated genes needs to be done to draw comprehensive conclusions.