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Evaluation of Postoperative Complication with Medically Necessary, Time-Sensitive Scoring System During Acute COVID-19 Pandemic: A Prospective Observational Study.
Dinçer, Müserref Beril; Güler, Meltem Merve; Gök, Ali Fuat Kaan; Ilhan, Mehmet; Orhan-Sungur, Mukadder; Özkan-Seyhan, Tülay; Koltka, Ahmet Kemalettin.
  • Dinçer MB; Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
  • Güler MM; Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
  • Gök AFK; Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
  • Ilhan M; Department of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
  • Orhan-Sungur M; Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
  • Özkan-Seyhan T; Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
  • Koltka AK; Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. Electronic address: ahmetkoltka@yahoo.com.
J Am Coll Surg ; 233(3): 435-444.e1, 2021 09.
Article in English | MEDLINE | ID: covidwho-1260777
ABSTRACT

BACKGROUND:

High scores in the Medically Necessary, Time-Sensitive (MeNTS) scoring system, used for elective surgical prioritization during the coronavirus disease 2019 pandemic, are assumed to be associated with worse outcomes. We aimed to evaluate the MeNTS scoring system in patients undergoing elective surgery during restricted capacity of our institution, with or without moderate or severe postoperative complications. STUDY

DESIGN:

In this prospective observational study, MeNTS scores of patients undergoing elective operations during May and June 2020 were calculated. Postoperative complication severity (classified as Group Clavien-Dindo < II or Group Clavien-Dindo ≥ II), as well as Duke Activity Index, American Society of Anesthesiologists (ASA) physical status, presence of smoking, leukocytosis, lymphopenia, elevated C-reactive protein (CRP), operation and anesthesia characteristics, intensive care requirement and duration, length of hospital stay, rehospitalization, and mortality were noted.

RESULTS:

There were 223 patients analyzed. MeNTS score was higher in the Clavien-Dindo ≥ II Group compared with the Clavien-Dindo < II Group (50.98 ± 8.98 vs 44.27 ± 8.90 respectively, p < 0.001). Duke activity status index (DASI) scores were lower, and American Society of Anesthesiologists physical status class, presence of smoking, leukocytosis, lymphopenia, elevated CRP, and intensive care requirement were higher in the Clavien-Dindo ≥ II Group (p < 0.01). Length of hospital stay was longer in the Clavien-Dindo ≥ II Group (15 [range 2-90] vs 4 [1-30] days; p < 0.001). Mortality was observed in 8 patients. Area under the receiver operating characteristic curve of MeNTS and DASI were 0.69 and 0.71, respectively, for predicting moderate/severe complications.

CONCLUSIONS:

Although significant, MeNTS score had low discriminating power in distinguishing patients with moderate/severe complications. Incorporation of a cardiovascular functional capacity measure could improve the scoring system.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Triage / Elective Surgical Procedures / Pandemics / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Am Coll Surg Journal subject: Gynecology / Obstetrics Year: 2021 Document Type: Article Affiliation country: J.jamcollsurg.2021.05.028

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Postoperative Complications / Triage / Elective Surgical Procedures / Pandemics / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: J Am Coll Surg Journal subject: Gynecology / Obstetrics Year: 2021 Document Type: Article Affiliation country: J.jamcollsurg.2021.05.028