Patients on the waiting list for surgery benefit from COVID-19 vaccination

Patients on the waiting list for elective surgery benefit from a COVID-19 vaccination prior to their operation. Globally, thousands of postoperative deaths due to the virus may be prevented.

These conclusions were drawn based on the data from a global study among more than 140,000 surgical patients. Schelto Kruijff, surgical oncologist at the UMCG and Jean-Paul de Vries, vascular surgeon and chair of the department of surgery at the UMCG, coordinated the Dutch contribution to this study. The results were published in the scientific journal British Journal of Surgery.

Increased mortality risk

Between 0.6% and 1.6% of patients undergoing elective surgery will develop a COVID-19 infection. This group is 4 to 8 times more likely to die within 30 days of surgery. The mortality rate of patients aged 70 years and over who undergo cancer surgery is usually 2.8%. The results of this study showed an increase in mortality rate to 18.6%, if they also developed a COVID-19 infection.

Preventing deaths

Based on their global study, the researchers conclude that vaccination of surgical patients prevents more COVID-19-related deaths than vaccination of the general population. In order to save one life for more than one year among the general population aged 70 years and over, it is necessary to vaccinate 1,840 people. However, only 351 vaccines need to be administered to patients aged 70 years and over who undergo cancer surgery. The researchers estimate that the implementation of global preoperative vaccinations will prevent approximately 58,000 COVID-19-related deaths in one year. This may be relevant to low and middle-income countries such as Africa and South America in particular because in these countries, other measures aimed at reducing the risk of complications usually cannot be taken.

Reducing the risk of elective surgery

According to Schelto Kruijff, preoperative vaccination can improve the outcome of elective surgery. ‘Preoperative vaccination substantially reduces the risk of COVID-19-related complications in patients. Globally, tens of thousands of postoperative deaths due to COVID-19 can be prevented. Due to the limited supply of vaccines, the first priority is currently to vaccinate the groups most likely to die from COVID-19. Our study can help to take such decisions based on solid research results. It is vitally important that policymakers use the data that we have collected to allow postponed elective surgery to be performed as safely as possible.’

Postponing elective surgery

During the first wave of the COVID-19 pandemic, up to 70% of elective surgery was postponed in some countries. As a result, an estimated 28 million operations globally were postponed or cancelled. In many countries, the number of operations is reaching levels prior to the COVID-19 pandemic. However, elective surgery will be likely to be postponed in 2021 as well, especially because many countries are being confronted with new waves of the COVID-19 pandemic. Preoperative vaccination is likely to reduce the number of postoperative complications. Therefore, intensive care units will be used less and total healthcare spending will be reduced as well.

More than 140,000 participating patients

This international study was led by researchers from the University of Birmingham. More than 15,000 surgeons from 1,672 hospitals across 116 countries collaborated in the research. They studied the data of more than 140,000 patients in total. It is one of the world’s largest and broadest studies on surgery ever. A recently published article in the scientific journal Anaesthesia written by this group of researchers showed that surgical procedures in patients who have tested positive for SARS-CoV-2 should be delayed for 7 weeks, if possible. COVID positive patients should delay surgery to reduce death risk (umcg.nl)