Scoring system to triage patients for spine surgery in the setting of limited resources: Application to the COVID-19 pandemic and beyond

Sciubba, Daniel M.; Ehresman, Jeff; Pennington, Zach; Lubelski, Daniel; Feghali, James; Bydon, Ali; Chou, Dean; Elder, Benjamin D.; Elsamadicy, Aladine A.; Goodwin, C. Rory; Goodwin, Matthew L.; Harrop, James; Klineberg, Eric O.; Laufer, Ilya; Lo, Sheng-Fu L.; Neuman, Brian J.; Passias, Peter G.; Protopsaltis, Themistocles; Shin, John H.; Theodore, Nicholas; Witham, Timothy F.; Benzel, Edward C.

Abstract Background As of May 04, 2020, the COVID-19 pandemic has affected over 3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems the world over leading to the cancellation of elective surgical cases and discussions regarding healthcare resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak, and may recur with future pandemics, creating a need for a means of triaging emergent and elective spine surgery patients. Methods Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. Results The devised scoring system included 8 independent components: neurological status, underlying spine stability, presentation of a high-risk post-operative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely-available web-based calculator (https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/). Conclusion Here we present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, while not all-encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.