Patients waiting for elective surgery should get COVID-19 vaccines ahead of the general population – potentially helping to avoid thousands of post-operative deaths linked to the virus, according to a new study funded by the NIHR.

Why should the government prioritise surgical patients for COVID-19 vaccination?

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 first 30 days following surgery. Normally, 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, while 1,840 people aged 70 years and over in the general population need to be vaccinated to save one life over one year, this figure is only 351 in patients aged 70 years and over having cancer surgery.

Risk reduction due to vaccination

Overall, scientists estimate that global prioritisation of pre-operative vaccination for elective patients could prevent 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, which can reduce the risk of complications related to the virus, are unlikely to be universally implemented.

Vaccination awareness

The COVIDSurg Collaborative international team of researchers, led by experts at the University of Birmingham, has published its findings today in BJS (incorporating the British Journal of Surgery and the European Journal of Surgery), after studying data for 141,582 patients from across 1,667 hospitals in 116 countries -including Australia, Brazil, China, India, UAE, UK and USA - creating the world’s largest-ever international study on surgery.

Co-lead author Mr Aneel Bhangu, from the University of Birmingham, commented, 

“Preoperative vaccination could support a safe re-start of elective surgery by significantly reducing the risk of COVID-19 complications in patients and preventing tens of thousands of COVID-19-related post-operative deaths. Many countries, particularly low- and middle-income countries, will not have widespread access to COVID-19 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.”

Importance of pre-operative vaccination

Co-lead author Dr Dmitri Nepogodiev, from the University of Birmingham, commented:

“Restarting elective surgery is a global priority. 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 policy makers 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.”

India is experiencing a second wave of COVID-19 and has made vaccines available. It will make sense for surgeons to insist on vaccination for elective surgery patients thus decreasing morbidity and leading to safe surgery. 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, the ongoing disruption is likely to continue throughout 2021, particularly in the event of countries experiencing further waves of COVID-19. Vaccination is also likely to decrease postoperative pulmonary complications - reducing intensive care use and overall healthcare costs.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.