Receiving COVID-19 vaccine before surgery would reduce risk of postoperative death

Patients waiting for elective surgery should get COVID-19 vaccines ahead of the general population. Globally this could help to avoid thousands of post-operative deaths linked to the virus, suggests a new international study.

Between 0.6% and 1.6% of patients develop COVID-19 infection after elective surgery. Patients who develop COVID-19 infection are at between 4- and 8-fold increased risk of death in the 30 days following surgery. For example, whereas patients aged 70 years and over undergoing cancer surgery would usually have a 2.8% mortality rate, this increases to 18.6% if they develop COVID-19 infection.

Based on the high risks that surgical patients face, scientists calculate that vaccination of surgical patients is more likely to prevent COVID-19 related deaths than vaccines given to the population at large – particularly among the over-70s and those undergoing surgery for cancer. “For example, 1,840 people aged 70 years and over in the general population need to be vaccinated to save one life over one year, but this figure is only 351 in patients aged 70 years and over having cancer surgery” says Joonas Kauppila, from the University of Oulu. He is the national lead for Finland in the CovidSurg Collaborative – research group, which is led by the University of Birmingham, UK.

Overall, the scientists estimate that global prioritisation of pre-operative vaccination for elective patients could prevent an additional 58,687 COVID-19-related deaths in one year. This could be particularly important for Low- and Middle-income Countries (LMICs) where mitigation measures such as nasal swab screening and COVID-free surgical pathways could be hard to implement, the scientists say.

The COVIDSurg Collaborative published its findings in British Journal of Surgery, after studying data for 141,582 patients from across 1,667 hospitals in 116 countries -including nearly 2,000 patients from Finland, Sweden and Denmark - creating the world’s largest ever international study on surgery.

Kauppila continues: “Preoperative vaccination could improve scaling up elective surgery. According to our analyses, correct prioritization of vaccinations could prevent tens of thousands of COVID-19-related post-operative deaths and even higher number of severe complications. Even though postoperative mortality rates in Finnish healthcare are lower than those presented here, these results are also applicable in Finland. The political decision-making related to the pandemic should be informed by scientific evidence, and we are doing well in vaccinating those at risk in Finland. In my opinion, planned surgery should also be included as one of the risk factors necessitating vaccination of the patient.”

During the first wave of the pandemic, up to 28 million elective surgeries were delayed or cancelled globally. Surgery volumes have started to recover, but many countries face high treatment debt, further complicated by new waves of COVID-19. The intensive care periods of those infected are long, and lead significant burden to the healthcare systems, causing costs and individual suffering. By vaccinating those at risk due to planned surgery could help reducing intensive care use and overall healthcare costs.

Kauppila adds: “Currently, cancer surgery is explicitly excluded from the The National Institution of Health and Welfare list of groups at risk, while those receiving for example chemotherapy are included. I think surgical patients should be added to the list of groups at risk”

“After deciding to offer surgical treatment, doctors should actively guide the patients to be vaccinated immediately, based on their individual risks. Of utmost importance is the vaccination of those in risk for also other reasons than surgery, those with planned cancer surgery, and other major surgery. It is good to note that these results cannot be applied to surgeries that already have taken place, and emergency procedures.”

Research article: CovidSurg Collaborative, GlobalSurg Collaborative. SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study. British Journal of Surgery, 2021. http://doi.org/10.1093/bjs/znab101

Main photo: Docent Joonas Kauppila, CovidSurg Collaborative National Lead in Finland.