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Cohn JA , Ghiraldi EM , Uzzo RG , Simhan J
A Critical Appraisal of the ACS "Medically-Necessary, Time-Sensitive Procedures" (MeNTS) Scoring System, Urology Consensus Recommendations, and Individual Surgeon Case Prioritization for Resumption of Elective Urologic Surgery During the COVID-19 Pandemic
J Urol. 2021 Jan;205(1) :241-247
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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 upon detailed cross-specialty questionnaires (QSP), specialty-specific published expert opinion (EOP), or by individual (operating) surgeon review (ISP). We aimed to evaluate 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 (3/9/20-5/22/20) using QSP (American College of Surgeons MeNTS instrument), EOP (based upon a published urologic recommendations), and ISP scoring (developed and managed within our department). Lower scores represented greater urgency. MeNTS scores were compared across EOP and ISP scores. RESULTS: 204 cases were evaluated. Median MeNTS score was 50 (IQR 44-55), and mean EOP and ISP scores were 2.6±0.6 and 2.2±0.8, respectively. Median MeNTS scores were 52 (46.5, 57.5), 50 (44.5, 54.5), 48 (43.5,54) for ISP priority 1, 2, and 3 cases (p=0.129) and 55 (51.5, 57), 47.5 (42, 56), and 49 (44, 54) for EOP priority scores 1, 2, and 3 (p=0.002). There was none to slight agreement between EOP and ISP scores (Kappa 0.131, p=0.002). CONCLUSIONS: Questionnaire-based, expert opinion-base, and individual surgeon-based approaches to case prioritization result in significantly different case prioritization. QSP did not meaningfully stratify urologic cases, and EOP and ISP frequently disagreed. The strengths and weaknesses of each of these systems should be considered in future disaster planning scenarios.
Notes
1527-3792 Cohn, Joshua A Ghiraldi, Eric M Uzzo, Robert G Simhan, Jay Journal Article United States J Urol. 2020 Jul 27:101097JU0000000000001315. doi: 10.1097/JU.0000000000001315.