Prabhakar Sumanth Madhusudan, Decruz Joshua, Kunnasegaran Remesh
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore.
Indian J Orthop. 2021 Mar 29;55(Suppl 2):314-322. doi: 10.1007/s43465-021-00392-8. eCollection 2021 Jul.
The reintroduction of elective Orthopaedic surgery during the COVID-19 pandemic is likely to occur in phases, dictated by resource limitations and loco-regional pandemic status. Guidelines providing a general framework for the prioritisation of surgery have largely been based on surgical urgency, while scoring systems such as the MeNTS score may have limited applicability in the setting of Orthopaedic Surgery. We, therefore, propose an Orthopaedic-specific algorithm ('MeNT-OS'), based on a modification of the MeNTS scoring system, that may be used to objectively triage and prioritise Orthopaedic cases during the COVID-19 pandemic.
We developed a scoring algorithm modified from the Medically Necessary Time-Sensitive Procedure (MeNTS) score with 13 unique variables, reflecting human and physical resource utilisation, surgical complexity, functional status of patients, as well as COVID-19 transmission risk. This score was then trialled in a sample of 118 cases, comprising 69 completed and 49 postponed cases. A higher overall score was intended to correlate with lower surgical prioritisation.
The use of our scoring system resulted in higher average scores for postponed cases compared to completed cases, as well as higher median, 25th and 75th percentile scores. These results were statistically significant and showed concordance with the ad hoc decisions made before the scoring system was used, with the lower scores for completed cases suggesting a more favourable risk-benefit ratio for being performed as compared to the postponed cases.
The utility of the proposed 'MeNT-OS' scoring system has been assessed using data from our institution and offers an objective and systematic approach that is geared towards Orthopaedic procedures. We believe this scoring tool can provide Orthopaedic surgeons a safe and equitable approach to making difficult decisions on prioritisation of surgery during the COVID-19 period, and possibly other resource-limited settings in the future.
在新冠疫情期间，择期骨科手术的恢复可能会分阶段进行，这取决于资源限制和当地疫情状况。提供手术优先级总体框架的指南主要基于手术紧迫性，而诸如MeNTS评分等系统在骨科手术环境中的适用性可能有限。因此，我们提出一种基于MeNTS评分系统修改的骨科专用算法（“MeNT-OS”），可用于在新冠疫情期间客观地对骨科病例进行分类和确定优先级。
我们开发了一种从医疗必要时间敏感程序（MeNTS）评分修改而来的评分算法，包含13个独特变量，反映人力和物力资源利用、手术复杂性、患者功能状态以及新冠病毒传播风险。然后在118例病例样本中试用该评分，其中包括69例已完成手术的病例和49例延期手术的病例。总体得分越高，表明手术优先级越低。
与已完成手术的病例相比，我们的评分系统在延期手术的病例中得出的平均得分更高，中位数、第25百分位数和第75百分位数得分也更高。这些结果具有统计学意义，并且与使用评分系统之前做出的临时决定一致，已完成手术病例的较低得分表明与延期手术的病例相比，其进行手术的风险效益比更有利。
已使用我们机构的数据评估了所提出的“MeNT-OS”评分系统的效用，该系统提供了一种针对骨科手术的客观且系统的方法。我们相信，这种评分工具可以为骨科医生提供一种安全且公平的方法，以便在新冠疫情期间以及未来可能的其他资源有限的情况下，就手术优先级做出艰难决策。
