SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
Trial registration: ClinicalTrials.gov NCT04509986.
National Institute for Health Research (NIHR) Global Health Research Unit grant (NIHR 16.136.79) using UK aid from the UK government to support global health research
Association of Coloproctology of Great Britain and Ireland
Bowel & Cancer Research
Bowel Disease Research Foundation
Association of Upper Gastrointestinal Surgeons
British Association of Surgical Oncology
British Gynaecological Cancer Society
European Society of Coloproctology
The Urology Foundation
Vascular Society for Great Britain and Ireland
Yorkshire Cancer Research
CommentsThe original article is available at https://academic.oup.com/
Published CitationCOVIDSurg Collaborative, GlobalSurg Collaborative. SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study. Br J Surg. 2021;108(9):1056-1063.
Publication Date24 March 2021
- Obstetrics and Gynaecology
- Beaumont Hospital
- Otolaryngology Head and Neck Surgery
- Surgical Science and Practice
PublisherOxford University Press (OUP)
- Published Version (Version of Record)