Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System for Operating Room Procedure Prioritization During the COVID-19 Pandemic.

Background The COVID-19 pandemic forced surgeons to reconsider concepts of "elective" surgery. Perceptions regarding the time-sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and health care workers; preservation of hospital beds and intensive care unit resources; and minimizing COVID-19 related perioperative risk to patients. Study design A scaffold for the complex decision-making required for prioritization of Medically Necessary, Time Sensitive (MeNTS) surgeries was developed for adult patients by colleagues at The University of Chicagoi. Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. Pediatric manifestations of chronic diseases and congenital anomalies were not accounted for. In order to account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties. Results This Pediatric MeNTS (pMeNTS) scoring system was applied to 101 cases both performed and deferred between March 23rd and April 19th, 2020, at The University of Chicago Comer Children's Hospital. The pMeNTS scores provides a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures. Conclusions This process is adaptable to individual institutions, and we project it will be useful during the acute phase of the pandemic (maximal limitations) as well as the anticipated recovery phase.