Implementing the medically necessary, time-sensitive surgical scoring system during the COVID-19 pandemic (original) (raw)
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Journal of The American College of Surgeons, 2020
BACKGROUND: The COVID-19 pandemic forced surgeons to reconsider concepts of "elective" operations. Perceptions about the time sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors, such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and healthcare workers; preservation of hospital beds and ICU resources; and minimizing COVID-19-related perioperative risk to patients. STUDY DESIGN: A scaffold for the complex decision-making required for prioritization of medically necessary, time-sensitive (MeNTS) operations was developed for adult patients by colleagues at the University of Chicago. Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. Pediatric manifestations of chronic diseases and congenital anomalies were not accounted for. To account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties. RESULTS: This pediatric MeNTS scoring system was applied to 101 cases both performed and deferred between March 23 and April 19, 2020 at the University of Chicago Comer Children's Hospital. The pediatric MeNTS scores provide a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures. CONCLUSIONS: This process is adaptable to individual institutions and we project it will be useful during the acute phase of the pandemic (maximal limitations), as well as the anticipated recovery phase.
Journal of The American College of Surgeons, 2021
BackgroundHigh scores in the Medically Necessary, Time-Sensitive (MeNTS) scoring system, used for elective surgical prioritization during the coronavirus disease 2019 pandemic, are assumed to be associated with worse outcomes. We aimed to evaluate the MeNTS scoring system in patients undergoing elective surgery during restricted capacity of our institution, with or without moderate or severe postoperative complications.Study DesignIn this prospective observational study, MeNTS scores of patients undergoing elective operations during May and June 2020 were calculated. Postoperative complication severity (classified as Group Clavien-Dindo < II or Group Clavien-Dindo ≥ II), as well as Duke Activity Index, American Society of Anesthesiologists (ASA) physical status, presence of smoking, leukocytosis, lymphopenia, elevated C-reactive protein (CRP), operation and anesthesia characteristics, intensive care requirement and duration, length of hospital stay, rehospitalization, and mortality were noted.ResultsThere were 223 patients analyzed. MeNTS score was higher in the Clavien-Dindo ≥ II Group compared with the Clavien-Dindo < II Group (50.98 ± 8.98 vs 44.27 ± 8.90 respectively, p < 0.001). Duke activity status index (DASI) scores were lower, and American Society of Anesthesiologists physical status class, presence of smoking, leukocytosis, lymphopenia, elevated CRP, and intensive care requirement were higher in the Clavien-Dindo ≥ II Group (p < 0.01). Length of hospital stay was longer in the Clavien-Dindo ≥ II Group (15 [range 2–90] vs 4 [1–30] days; p < 0.001). Mortality was observed in 8 patients. Area under the receiver operating characteristic curve of MeNTS and DASI were 0.69 and 0.71, respectively, for predicting moderate/severe complications.ConclusionsAlthough significant, MeNTS score had low discriminating power in distinguishing patients with moderate/severe complications. Incorporation of a cardiovascular functional capacity measure could improve the scoring system.Open in a separate window
Optimal Timing of Elective Surgery after Covid 19 Infection
Zenodo (CERN European Organization for Nuclear Research), 2022
Introduction: Scheduling surgeries and management of surgical emergencies have been revolutionized by the outbreak of the novel coronavirus disease (COVID-19). The aim of this study was to determine the optimum timing of elective surgery for patients after COVID-19 infection in order to operate the deserving patients and avoid future burden on the health care facility and staff.
Bone & Joint Open
Aims Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. Methods A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. Results A ...
Sao Paulo Medical Journal
BACKGROUND: The COVID-19 pandemic is threatening healthcare systems and hospital operations on a global scale. Treatment algorithms have changed in general surgery clinics, as in other medical disciplines providing emergency services, with greater changes seen especially in pandemic hospitals. OBJECTIVES: To evaluate the follow-up of patients undergoing emergency surgery in our hospital during the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level public hospital. METHODS: The emergency surgeries carried out between March 11 and April 2, 2020, in the general surgery clinic of a tertiary-care hospital that has also taken on the functions of a pandemic hospital, were retrospectively examined. RESULTS: A total of 25 patients were included, among whom 20 were discharged without event, one remained in the surgical intensive care unit, two are under follow-up by the surgery service and two died. Upon developing postoperative fever and shortness of breath, two patients underwent thoracic computed tomography (CT), although no characteristics indicating COVID-19 were found. The discharged patients had no COVID-19 positivity at follow-up. CONCLUSION: The data that we obtained were not surgical results from patients with COVID-19 infection. They were the results from emergency surgeries on patients who were not infected with COVID-19 but were in a hospital largely dealing with the pandemic. Analysis on the cases in this study showed that both the patients with emergency surgery and the patients with COVİD infection were successfully treated, without influencing each other, through appropriate isolation measures, although managed in the same hospital. In addition, these successful results were supported by 14-day follow-up after discharge.
Catheterization and Cardiovascular Interventions, 2020
Background: Following the surge of the coronavirus disease 2019 (COVID-19) pandemic, government regulations, and recommendations from professional societies have conditioned the resumption of elective surgical and cardiovascular (CV) procedures on having strategies to prioritize cases because of concerns regarding the availability of sufficient resources and the risk of COVID-19 transmission. Objectives: We evaluated the use of a scoring system for standardized triage of elective CV procedures. Methods: We retrospectively reviewed records of patients scheduled for elective CV procedures that were prioritized ad hoc to be either performed or deferred when New Jersey state orders limited the performance of elective procedures due to the COVID-19 pandemic. Patients in both groups were scored using our proposed CV medically necessary, time-sensitive (MeNTS) procedure scorecard, designed to stratify procedures based on a composite measure of hospital resource utilization, risk of COVID-19 exposure, and time sensitivity. Results: A total of 109 scheduled elective procedures were either deferred (n = 58) or performed (n = 51). The median and mean cumulative CV MeNTS scores for the group of performed cases were significantly lower than for the deferred group (26 (interquartile range (IQR) 22-31) vs. 33 (IQR 28-39), p < .001, and 26.4 (SE 0.34) vs. 32.9 (SE 0.35), p < .001, respectively). Conclusions: The CV MeNTS procedure score was able to stratify elective cases that were either performed or deferred using an ad hoc strategy. Our findings suggest that the CV MeNTS procedure scorecard may be useful for the fair triage of elective CV cases during the time when available capacity may be limited due to the COVID-19 pandemic.
Aim: Even during COVID-19 epidemic, doctors desperately want instructions on how to provide medical assistance in a safe and competent manner. The aim was to determine the essential domains that should be taken into account while creating epidemic preparation strategies for surgical facilities. Methods: This scoping search remained carried out to discover available literature on the care of postoperative pain throughout pandemics. In order to recognize major difficulties and options to bringing successful surgical services as throughout COVID-19 pandemic, focus group interviews remained undertaken with surgeons and anesthetists having direct experience of dealing throughout outbreaks of infectious diseases. Results: The scoping search yielded fourteen papers, and surgeons and anesthetists from 13 different countries were questioned. The epidemic action plan for surgical services must remain prepared in advance to mount an effective reaction to COVID-19. Facility of staff training (including such care transitions, donning and doffing protective clothing, and acknowledging and able to manage COVID-19 illness); support for the hospital inpatient reply to COVID-19 (reduction in non-urgent operations like treatment facilities, endoscopy, and non-urgent elective surgery); development of the team-founded method for running ambulance service; also acknowledgment and strategic planning of COVID-19 disease in people are important areas that are included. The backlog of operations following conclusion of COVID-19 epidemic is unavoidable, also hospitals must prepare how to deal with it efficiently so that people undergoing elective therapy get the ideal outcomes. Conclusion: Hospitals must develop thorough context-specific epidemic contingency strategies that address the topics outlined. Clear criteria must be revised on a regular basis to reflect fresh information as during COVID-19 epidemic.
Prioritizing surgery during the COVID-19 pandemic: the Quebec guidelines
Canadian Journal of Surgery, 2021
In many countries, health care institutions have ramped down nonemergent activities in order to free up hospital and critical care beds in anticipation of a wave of patients with coronavirus disease 2019 (COVID-19). Medical activities were reduced to a minimum, leaving operating rooms to run semiurgent and urgent surgeries only. The status quo of systematically prioritizing resources away from surgical care to patients with COVID-19 may lead to unintended long-term outcomes. We propose a 4-step prioritization system based on resource availability and clinical criteria, as well as supplemental triage criteria for instances where multiple patients have equal claims to priority. The algorithm aims to guide clinicians and decision-makers toward allocating resources to surgical patients while still optimizing pandemicspecific benefits to the population.