Reliability and Validity of Two Surgical Prioritization Systems for Non-Emergent Gynecologic Surgery during the COVID Pandemic

Study Objective Scientifically evaluate the validity and reproducibility of two novel surgical triaging systems, as well as offer modifications to the MeNTS criteria for improved application in gynecologic surgeries Design Retrospective cohort study Setting Academic university hospital Patients or Participants 97 patients with delayed benign gynecologic procedures due to the COVID pandemic Interventions Surgical prioritization was assessed using two novel scoring systems, the Gyn-MenTS and mESAS systems for all 93 patients included Measurements and Main Results The inter-rater reliability and validity of 2 novel surgical prioritization systems (Gyn-MeNTS and mESAS) were assessed Gyn-MeNTS scores were calculated by 3 raters and analyzed as continuous variables, with a lower score indicating more urgency/priority The mESAS score was calculated by 2 raters and analyzed as a 3-level ordinal variable with a higher score indicating more urgency/priority All 5 raters were blinded to reduce bias Gyn-MeNTS inter-rater reliability was tested using Spearman r and paired t-tests were used to detect systematic differences between raters Weighted kappa indicated mESAS reliability Concurrent validity with mESAS and surgeon self-prioritization (SSP) was examined with Spearman r and logistic regression Spearman r's for all Gyn-MeNTS rater pairs were above 0 80 (0 84 for 1 vs 2, 0 82 for 1 vs 3, 0 82 for 2 vs 3, all p< 0001) indicating strong agreement The weighted kappa for the 2 mESAS raters was 0 57 (95% CI 0 40-0 73) indicating moderate agreement When used together, both scores were significantly independently associated with SSP, with strong discrimination (AUC 0 89) Conclusion Inter-rater reliability is acceptable for both scoring systems, and concurrent validity of each is moderate for predicting SSP, but discrimination improves to a high level when they are used together