• Müşerref Beril Dinçer, Meltem Merve Güler, GökAli Fuat KaanAFKDepartment of Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey., Mehmet İlhan, Mukadder Orhan-Sungur, Tülay Özkan-Seyhan, and Ahmet Kemalettin Koltka.
• Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
• J. Am. Coll. Surg. 2021 Sep 1; 233 (3): 435-444.e1.

BackgroundHigh 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 DesignIn 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.ResultsThere 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.ConclusionsAlthough 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.Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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