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

Patients receiving elective surgery for COVID-19 vaccine should be given priority over the general population, a global modeling study suggested.

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

Elderly patients who needed cancer surgery would get the most benefit, the team wrote in the 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 joint postoperative deaths. related to COVID-19, “co – author Aneel Bhangu, PhD, of the University of Birmingham in England, said in a statement.

The researchers said that patients who develop COVID-19 infection are four to eight times more at risk of death within 30 days of surgery, and that a patient older than 2.8% would have a mortality rate of 2.8%. 70 require cancer surgery, but usually, but that rises to 18.6% if patients have COVID-19.

The authors stated that selected surgeries could be canceled or postponed again if waves of COVID-19 continue throughout 2021, and suggested that prioritization of the -this population for vaccination even postoperative lung problems, ICU use, and total health care costs.

For this analysis, Bhangu and colleagues analyzed data from the GlobalSurg-COVIDSurg study, spanning nearly 1,700 hospitals in 116 countries. In total, 56,589 patients were admitted. Postoperative SARS-CoV-2 positivity was 0.96%. Enhanced analyzes also revealed a significant association between COVID-19 infection and 30-day postoperative mortality.

The researchers obtained their estimates from postoperative SARS-CoV-2 levels and mortality in an international cohort of surgical patients compared with SARS-CoV-2 incidence data and case mortality in the general population. space.

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

And the numbers required for vaccination to prevent a single COVID-19-related death over 30 days were 425 among patients age 70 and older who required cancer surgery versus 22,384 for the general population.

“Vaccine implementation for surgical patients needs to develop preoperative pathways to deliver vaccination in advance of planned surgery dates,” the authors wrote. “These pathways should be designed in conjunction with broader system developments that aimed at reducing nosocomial SARS-CoV-2 transmission, such as preoperative SARS-CoV-2 swab testing and COVID-free surgical pathways. “

The group noted that these estimates should be “carefully interpreted,” and will vary with the frequency of COVID-19. In addition, as this was a global study, it may be regionally appropriate. And, the researchers said, case mortality rates were based on data from England, and vaccine efficacy rates were based on clinical trials, not efficacy in surgical patients in particular.

Last Updated March 25, 2021