A Critical Appraisal of the American College of Surgeons Medically Necessary, Time Sensitive Procedures (MeNTS) Scoring System, Urology Consensus Recommendations and Individual Surgeon Case Prioritization for Resumption of Elective Urological Surgery During the COVID-19 Pandemic

Abstract

Purpose: Resumption of elective urology cases postponed due to the COVID-19 pandemic requires a systematic approach to case prioritization, which may be based on detailed cross-specialty questionnaires, specialty specific published expert opinion or by individual (operating) surgeon review. We evaluated whether each of these systems effectively stratifies cases and for agreement between approaches in order to inform departmental policy. Materials and Methods: We evaluated triage of elective cases postponed within our department due to the COVID-19 pandemic (March 9, 2020 to May 22, 2020) using questionnaire based surgical prioritization (American College of Surgeons Medically Necessary, Time Sensitive Procedures [MeNTS] instrument), consensus/expert opinion based surgical prioritization (based on published urological recommendations) and individual surgeon based surgical prioritization scoring (developed and managed within our department). Lower scores represented greater urgency. MeNTS scores were compared across consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores. Results: A total of 204 cases were evaluated. Median MeNTS score was 50 (IQR 44, 55), and mean consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores were 2.6AE0.6 and 2.2AE0.8, respectively.

Endocrine Surgical Procedures During COVID-19: Patient Prioritization and Time to Surgery

“…Although the MeNTS system is a well-intentioned and thoughtful assessment of patient, disease and procedure factors, the complexity of clinical care may exceed the capacity of a single scoring system. A similar observation has been made in gynecologic and urologic surgery, where the broad MeNTS system did not well-discriminate urgent cases and performed less well than compared to a modified surgical acuity scale or individual surgeon prioritization 15 , 16 . Prioritization systems that better discriminate urgent cases are being developed in individual specialties.…”

“…Elective surgical delays related to COVID-19 created an unprecedented situation requiring first procedure triage, and then prioritization of procedure rescheduling. Several scoring systems have been developed to capture patient and procedure characteristics to guide these challenging management decisions 8 , 9 , 10 , 11 , 12 , 15 , 16 . Due to the rapidly evolving public health crisis, these scoring systems were of necessity developed and implemented without external validation.…”

The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre

“…As hospitals try to resume elective care, there needs to be fair division of resources based upon prioritisation of cases which is challenging in itself due to differences in surgeon and speciality preferences. 17…”

Evaluation of Postoperative Complication with Medically Necessary, Time-Sensitive Scoring System During Acute COVID-19 Pandemic: A Prospective Observational Study

“…But the MeNTS scoring system for prioritization is not studied extensively. Cohn et al have studied the scoring system in terms of its overlap for patient prioritization comparing surgical branch consensus/expert opinion based and individual surgeon based systems 19 , whereas others questioned the reliability of modified MeNTS scores for different types of surgical branches for triage. 20 , 21 A modified scoring system for pediatric patients (pMeNTS) was also described by Slidell et al 22 , and it was mentioned that deferred cases had higher scores similar to the results of Prachand et al 12 However, until our study, score is not evaluated in real life circumstances with postoperative complication and outcome data.…”

“…Interestingly, when the patients with these abnormalities are compared to those without, MeNTS scores were similar. MeNTS score, as a part of patient factors, questions the presence of influenza-like illness (fever, cough, body aches, sore throat, diarrhea) for COVID symptoms but does not incorporate laboratory values similar to other prioritization scores or modifications proposed 19 , 20 , 21 , 22 which may be a limitation of the scoring. Questioning of COVID symptoms/exposure may seem redundant in this era given that PCR testing is an accepted standard for surgery during pandemic.…”