A Tale of Two Pathways: Same‐Surgeon Versus Different‐Surgeon Resection After Second Surgical Opinion

BACKGROUND: The role of second surgical opinions (SSOs) in gastrointestinal (GI) cancer care is not well-defined. While SSOs are common, the impact may depend on whether patients ultimately undergo resection with the same surgeon or with a different surgeon after the SSO. We sought to characterize perioperative outcomes relative to SSO among older adults with GI cancers. METHODS: Using SEER-Medicare data (2000-2019), patients aged 66-90 with primary GI were identified. Cancer-directed resections were categorized into three claims-observed pathways: surgery without SSO, SSO with same-surgeon resection, and SSO with different-surgeon resection. Multivariable regression models assessed the association between operative pathway and perioperative outcomes including complications, extended length of stay (LOS), 90-day readmission and mortality, discharge disposition, and achievement of a composite "textbook outcome." RESULTS: Among 40,603 surgical patients, 56.2% underwent surgery without SSO, 5.3% underwent SSO with same-surgeon resection, and 38.5% underwent SSO with different-surgeon resection. Compared with no SSO, SSO followed by resection with a different surgeon was associated with lower odds of 90-day readmission (aOR 0.92, 95%CI 0.88-0.97), any complications (aOR 0.90, 95%CI 0.84-0.95), extended LOS (aOR 0.93, 95%CI 0.88-0.98), and mortality (aOR 0.67, 95%CI 0.58-0.78), as well as higher discharge-home (aOR 1.05, 95%CI 1.01-1.12) and textbook outcome (aOR 1.12, 95%CI 1.07-1.17). In contrast, SSO with same-surgeon resection was associated with higher complications (aOR 1.14, 95%CI 1.01-1.29), longer LOS (aOR 1.21, 95%CI1.09-1.35), and lower home discharge (aOR 0.77, 95%CI 0.70-0.85) with no survival advantage. CONCLUSION: Among older adults undergoing GI cancer surgery, SSO followed by resection with a different surgeon was associated with improved perioperative safety and recovery, whereas SSO followed by resection with the same surgeon was not associated with similar benefit. These findings suggest that the value of SSO may lie in its role as a pathway to a different surgical team when clinically appropriate.