COVID-19 vaccine before surgery to reduce postoperative deaths: study

Researchers from a collaborative international study have urged governments to prioritise vaccinating patients waiting for elective surgery against COVID-19. The COVIDSurg Collaborative international team of researchers, led by experts at the University of Birmingham in the UK, said vaccinating surgical patients ahead of the general population has the potential to help avoid thousands of postoperative deaths linked to the virus. The National Institute for Health Research-funded study found that this was particularly true for those aged over 70 years and those undergoing surgery for cancer.

With findings published in BJS (incorporating the British Journal of Surgery and the European Journal of Surgery), the study examined data from 141,582 patients across 1667 hospitals in 116 countries — including Australia, Brazil, China, India, Japan, Nigeria, UAE, the UK and the USA — creating what is believed to be the world’s largest ever international study on surgery.

Between 0.6% and 1.6% of patients develop COVID-19 infection after elective surgery. Patients who develop COVID-19 infection are between a four- and eight-fold increased risk of death in the 30 days following surgery. Patients aged 70 years and over undergoing cancer surgery would usually have a 2.8% mortality rate, but this increases to 18.6% if they develop COVID-19.

Overall, the scientists estimate that global prioritisation of preoperative vaccination for elective patients could prevent an additional 58,687 COVID-19-related deaths in one year.

Co-lead author Aneel Bhangu, from the University of Birmingham, said, “Preoperative vaccination could support a safe restart of elective surgery by significantly reducing the risk of COVID-19 complications in patients and preventing tens of thousands of COVID-19-related postoperative deaths.

“Many countries, particularly low- and middle-income countries, will not have widespread access to COVID [vaccines] for several years. While vaccine supplies are limited, governments are prioritising vaccination for groups at highest risk of COVID-19 mortality. Our work can help to inform these decisions.”

“Restarting elective surgery is a global priority,” said co-lead author Dr Dmitri Nepogodiev from the University of Birmingham. “Over 15,000 surgeons and anaesthetists from across 116 countries came together to contribute to this study, making it the largest ever scientific collaboration. It’s crucial that policymakers use the data we have collected to support a safe restart to elective surgery; COVID vaccination should be prioritised for elective surgery patients ahead of the general population.”

During the first wave of the pandemic, up to 70% of elective surgeries were postponed, resulting in an estimated 28 million procedures being delayed or cancelled. Whilst surgery volumes have started to recover in many countries, ongoing disruption is likely to continue throughout 2021, particularly in the event of countries experiencing further waves of COVID-19.

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