Integration of functional capacity to medically necessary, time-sensitive scoring system A prospective observational study

Abstract

Objectives: To evaluate 2 new modifications to medically necessary, time-sensitive(MeNTS)scoring systems integrating functional capacity assessment in estimating intensive care unit(ICU)requirements. Methods: This prospective observational study included patients undergoing elective surgeries between July 2021 and January 2022. The MeNTS scores and our 2 modified scores: MeNTS-METs(integrated Duke activity status index [DASI] as metabolic equivalents [METs])and MeNTS-DASI-5Q(integrated modified DASI [M-DASI] as 5 questions)were calculated. The patients’ ICU requirements(group ICU+ and group ICU-), DASIs, patient-surgery-anesthesia characteristics, hospital stay lengths, rehospitalizations, postoperative complications, and mortality were recorded. Results: This study analyzed 718 patients. The MeNTS, MeNTS-METs, and MeNTS-DASI-5Q scores were higher in group ICU+ than in group ICU-(p<0.001). Group ICU+ had longer operation durations and hospital stay lengths(p<0.001), lower DASI scores(p<0.001), and greater hospital readmissions, postoperative complications, and mortality(p<0.001). The MeNTS-METs and MeNTS-DASI-5Q scores better predicted ICU requirement with areas under the receiver operating characteristic curve(AUC)of 0.806 and 0.804, than the original MeNTS(AUC=0.782). Conclusion: The 5-questionnaire M-DASI is easy to calculate and, when added to a triage score, is as reliable as the original DASI for predicting postoperative ICU requirements.