Sharma Arun, Matos Sophia, Ettema Sandra L, Gregory Stacie R, Javadi Pardis, Johnson Matthew D, Stack Brendan C, Crosby Dana L
Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
OTO Open. 2021 May 4;5(2):2473974X211012664. doi: 10.1177/2473974X211012664. eCollection 2021 Apr-Jun.
To develop and assess an otolaryngology-specific surgical priority scoring system that incorporates varying levels of mucosal involvement.
Retrospective cohort.
Academic medical center.
A novel mucosal score was developed based on best available evidence. This mucosal score was incorporated into the Medically Necessary, Time-Sensitive (MeNTS) score to generate a MeNTS-Mucosal (MeNTS-M) score. A retrospective cohort of patients was identified to assess the surgical priority scoring systems. Inclusion criteria included all scheduled surgical procedures between March 23, 2020, and April 17, 2020. Decisions about whether to proceed or cancel were made based on best clinical judgment by surgeons, without use of any surgical priority scores. The predictive value of the surgical priority scoring systems was assessed in this retrospective cohort.
The median MeNTS score was significantly lower in adult patients whose surgery proceeded compared to those for whom the surgery was cancelled (48 vs 56; = .004). Mucosal and MeNTS-M scores were not statistically different based on whether surgery proceeded. Among adult patients, the highest area under the curve (AUC) was for the MeNTS scoring system (0.794); both the mucosal and MeNTS-M systems had lower AUC values (which were significantly lower than the AUC for the MeNTS scoring system).
This study represents development and assessment of the first otolaryngology-specific surgical priority score and incorporates varying levels of mucosal disruption. The combined MeNTS-M scoring system could be a valuable tool in appropriately triaging otolaryngology-head and neck surgery procedures.
开发并评估一种纳入不同程度黏膜受累情况的耳鼻喉科特异性手术优先级评分系统。
回顾性队列研究。
学术医疗中心。
基于现有最佳证据开发了一种新的黏膜评分。该黏膜评分被纳入医疗必需、时间敏感（MeNTS）评分中，以生成MeNTS-黏膜（MeNTS-M）评分。确定了一个回顾性患者队列，以评估手术优先级评分系统。纳入标准包括2020年3月23日至2020年4月17日期间所有预定的外科手术。关于是否进行手术或取消手术的决定由外科医生根据最佳临床判断做出，未使用任何手术优先级评分。在这个回顾性队列中评估了手术优先级评分系统的预测价值。
与手术被取消的成年患者相比，手术得以进行的成年患者的MeNTS评分中位数显著更低（48对56；P = 0.004）。根据手术是否进行，黏膜评分和MeNTS-M评分在统计学上没有差异。在成年患者中，曲线下面积（AUC）最高的是MeNTS评分系统（0.794）；黏膜评分系统和MeNTS-M评分系统的AUC值均较低（且显著低于MeNTS评分系统的AUC）。
本研究代表了首个耳鼻喉科特异性手术优先级评分的开发与评估，并纳入了不同程度的黏膜破坏情况。联合的MeNTS-M评分系统可能是对耳鼻喉科头颈外科手术进行适当分类的有价值工具。
