Model: Give COVID-19 vaccine to all patients before surgery

Patients undergoing elective surgery should have priority for vaccination against COVID-19 over the general population, a global modeling study has suggested.

Such a policy could prevent over 56,000 deaths from COVID-19 worldwide, the COVIDSurg Collaborative, a multinational group of surgeons and anesthesiologists in more than 80 countries, reported.

Elderly patients who need cancer surgery would benefit the most, the team wrote British Journal of Surgery.

“Preoperative vaccination could support the safe resumption of elective surgery by significantly reducing the risk of COVID-19 complications in patients and preventing tens of thousands of post-operative deaths associated with COVID-19,” said co-author Dr. Aneel Bhangu, of the University of Birmingham in England, in a statement.

The researchers added that patients who developed COVID-19 infection had a four to eight times higher risk of death within 30 days of surgery, and that a patient over the age of 70 who needed cancer surgery would typically have a 2.8% mortality rate. but this increases to 18.6% if patients have COVID-19.

The authors said election operations could be canceled or delayed again if COVID-19 waves last through 2021, and speculated that prioritizing this population for vaccination could even reduce postoperative pulmonary complications, ICU use, and overall health care costs.

For this analysis, Bhangu and colleagues examined data from the GlobalSurg-COVIDSurg study, which included nearly 1,700 hospitals in 116 countries. A total of 56,589 patients were included. The positive positivity for SARS-CoV-2 was 0.96%. Customized analyzes also showed a significant association between COVID-19 infection and 30-day postoperative mortality.

The researchers performed estimates from postoperative SARS-CoV-2 rates and mortality in an international cohort of surgical patients compared with data on the incidence and mortality of SARS-CoV-2 cases in the general population.

The numbers needed for vaccination to prevent one COVID-related death in one year were 1,840 for the general population, but only 351 for patients older than 70 years and older who underwent cancer surgery.

The numbers required for vaccination to prevent death from COVID-19 over 30 days were 425 among patients 70 years of age and older who required cancer surgery, compared with 22,384 for the general population.

“The implementation of vaccination for surgical patients will require the development of preoperative vaccination routes before the planned dates of surgery,” the authors wrote. “These pathways should be designed in conjunction with broader systemic development aimed at reducing nosocomial transmission of SARS-CoV-2, such as preoperative SARS-CoV-2 swab testing and COVID-free surgical pathways.”

The group noted that these estimates “should be interpreted with caution” and would vary with the prevalence of COVID-19. In addition, since this was a global study, its regional applicability may be limited. The researchers said that the mortality rates were based on data from England, and the effectiveness of vaccines in clinical trials, and not on the effectiveness in surgical patients.

Last updated March 25, 2021

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The study was supported by the Global Health Research Unit of the National Institutes of Health (NIHR), the Coloproctology Association of Great Britain and Ireland, Bowel and Cancer Research, Bowel Research Foundation, Association of Upper Gastrointestinal Surgeons, British Surgical Oncology Association, British Gynecological Cancer Society , European Society of Coloproctology, NIHR Academy, Sarcoma UK, The Urology Foundation, Vascular Society of Great Britain and Ireland and Yorkshire Research of Cancer Research.

The authors did not reveal a conflict of interest and noted that the views expressed were not necessarily those of the National Health Service, the NIHR or the UK Ministry of Health and Welfare.

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