The Ments Criteria - Can We Apply It in Dialysis Access Surgery?

ABSTRACT

Introduction: Dialysis access surgery, in the UK, is almost always performed in NHS healthboard-run hospitals. During the height of the COVID-19 pandemic, in which access to elective operating theatres became limited, arrangements were made in our vascular access service, to perform some dialysis access surgery in a local private hospital. Patients were selected such that those deemed suitable as day-case and unlikely to require in-patient stay were chosen. A scoring system, 'Medically Necessary Time-Sensitive' (MeNTS) criteria, was proposed recently to assist in such decision-making processes by considering procedural, disease, and patient factors (Prachand et al, J Am Coll Surg.2020). The cumulative MeNTS score ranges from 21 to 105, with a score >65 signifying a 'too high risk to be justified' procedure. The aim of this study was to use MeNTS scores retrospectively to determine whether correct decisions were made in performing dialysis-access operations in the usual NHS university healthboard (UHB) setting vs local private hospital (Spire). Method(s) MeNTS scores were calculated for all patients who underwent dialysis access surgery at both sites between March 2020 - March 2021. Outcomes assessed included patient survival and COVID-19 infection Results: 213 Patients underwent dialysis access surgery at UHB and 76 at Spire. Mean cumulative MeNTS scores were 40.03(+/-0.30) and 39.97(+/-0.46) for the UHB and Spire groups, respectively (P=.922). COVID-19 infection occurred in four patients at UHB, and none in Spire (P=.576). Successful dialysis access was achieved in 76.06% and 69.74% in UHB and Spire patients, respectively (P=.287). At 30 days, one UHB patient had died whilst all Spire patients were alive (P>.999). Discussion and conclusion: Dialysis access surgery can take place safely during the COVID-19 pandemic, with necessary precautions. A modified version of the MeNTS score to make it more renal-specific would allow maximum benefit to be achieved from it in this field.