How COVID-19 vaccine reduces risk of postoperative death

*Researchers recommend patients should receive jab before surgery, urge governments to prioritise surgical patients for coronavirus immunisation

British and Nigerian researchers have recommended that 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.

The researchers, according to a new study funded by the National Institute for Health Research (NIHR), the United Kingdom (UK), found that between 0.6 per cent and 1.6 per cent of patients develop COVID-19 infection after elective surgery. They found patients who develop COVID-19 infection are at between four- and eight-fold increased risks 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 per cent mortality rate, this increases to 18.6 per cent if they develop COVID-19 infection.

Based on the high risks that surgical patients face, the 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, whereas 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.

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.

They said 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.

The COVIDSurg Collaborative international team of researchers, led by experts at the University of Birmingham, UK has scheduled to publish 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, Nigeria, 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 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.”

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.”

Co-lead author and national lead for Nigeria, Prof. Adesoji Ademuyiwa, from the Department of Surgery, College of Medicine, University of Lagos (CMUL), commented: “Indeed vaccine supplies in LMICs are limited, but it is imperative to consider patients about to undergo elective surgery as a high risk group for COVID-19 vaccination.”

During the first wave of the pandemic, up to 70 per cent of elective surgeries were postponed, resulting in an estimated 28 million procedures being delayed or cancelled. While surgery volumes have started to recover in many countries, on-going 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 post-operative pulmonary

The University of Birmingham is ranked among the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 6,500 international students from over 150 countries.

“SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study” – COVIDSurg Collaborative is published by the British Journal of Surgery.