Prioritizing elective cardiovascular procedures during the COVID‐19 pandemic: The cardiovascular medically necessary, time‐sensitive procedure scorecard

Abstract

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.

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

“…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. This novel study for the first time demonstrates that patients with moderate or severe postoperative complications had higher preoperatively calculated MeNTS scores.…”

“…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.…”

A prioritization score for elective urological surgery during the COVID-19 pandemic: The Medically Necessary Time-Sensitive (MeNTS) score system

“…At the moment, there is little scientific evidence concerning surgical prioritization markers, including the MeNTS score. Only four studies have been published about the utility of this scoring system and all of them have been applied in different fields and compared different groups, [8][9][10][11] so little conclusion can be made. In this study, we present the first comparative analysis of MeNTS scores between operated and deferred cases in a urological department.…”

Reshaping care in the aftermath of the pandemic. Implications for cardiology health systems

“…On the other hand, the EAPCI gave a prominent role to thrombolysis as the strategy of choice in scenarios where immediate access to the catheterisation suite was not possible, due to lack of staff or bed saturation, and favoured ventriculography to assess ventricular function in all patients without prior echocardiography [ 88 ]. Furthermore, an impressive reduction in the number of elective procedures in cardiology departments was observed during the pandemic [ 89 , 90 ].…”