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SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

pmid: 33761533
pmc: PMC7995808
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
Abstract 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.
The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous.
- Federal University of Mato Grosso do Sul Brazil
- University of Trieste Italy
- University of Edinburgh United Kingdom
- University of Southern Denmark Denmark
- Aarhus University Denmark
Microsoft Academic Graph classification: Case fatality rate Medicine education.field_of_study Vaccination Cohort study medicine.medical_specialty Elective surgery education Prospective cohort study Incidence (epidemiology) Population business.industry Number needed to vaccinate Emergency medicine business
Dewey Decimal Classification: ddc:610
Male, COVID-19 Vaccine, safe surgery; vaccination modelling; COVID-19, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MULTICENTER, Comorbidity, phase 3 clinical trial (topic), Prospective Studies, SARS-CoV-2 , Vaccination , Safe surgery, COVID-19/epidemiology, SARS-CoV-2 ; vaccination ; safe surgery, case fatality rate, Vaccination, Adolescent; Adult; Aged; COVID-19; COVID-19 Vaccines; Comorbidity; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Period; Prospective Studies; SARS-CoV-2; Vaccination; Young Adult, health care policy, Elective Surgical Procedures, vaccination modelling, Preoperative Period, COVID-19; SARS-CoV-2; cancer; vaccination; outcome; mortality; infection; modelling, prospective study, Article, SARS-CoV-2, vaccination, SDG 3 - Good Health and Well-being, COVID-19 Vaccines/pharmacology, Humans, Vaccination/methods, human, Aged, Science & Technology, Elective Surgical Procedure, adult; aged; Article; cancer grading; cancer surgery; case fatality rate; computer assisted tomography; elective surgery; female; follow up; health care policy; human; incidence; infection rate; infection risk; major clinical study; male; middle aged; mortality; outcome assessment; phase 3 clinical trial (topic); preoperative care; prospective study; sensitivity analysis; seroprevalence; Severe acute respiratory syndrome coronavirus 2; vaccination; young adult; COVID-19; COVID-19 Vaccines; Comorbidity; Elective Surgical Procedures; Postoperative Complications; Preoperative Period; SARS-CoV-2; Vaccination; surgery., Cura preoperatòria, major clinical study, mortality, infection, Prospective Studie, incidence, Surgery, Postoperative Complication, Human medicine, 610 Medizin und Gesundheit, AcademicSubjects/MED00910, Settore MED/29 - CHIRURGIA MAXILLOFACCIALE, Settore MED/18 - CHIRURGIA GENERALE, computer assisted tomography, ESTUDOS PROSPECTIVOS, surgery, safe surgery, Postoperative Complications, sensitivity analysis, Severe acute respiratory syndrome coronavirus 2, preoperative care, Vacunació, seroprevalence, covid, Elective Surgical Procedures/methods, Middle Aged, COVID, vaccination, cancer grading, outcome, /dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being, SARS-CoV-2; vaccination; surgery, Female, Original Article, cancer surgery, AcademicSubjects/MED00010, Life Sciences & Biomedicine, Adult, COVID-19 Vaccines, Adolescent, international prospective cohort study, Postoperative Complications/prevention & control, infection rate, SARS-CoV-2/immunology, NO, modelling, Young Adult, follow up, cancer, infection risk, outcome assessment, LS7_4, SARS-CoV-2, Preoperative care, COVID-19, 3126 Surgery, anesthesiology, intensive care, radiology, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], elective surgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Male, COVID-19 Vaccine, safe surgery; vaccination modelling; COVID-19, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MULTICENTER, Comorbidity, phase 3 clinical trial (topic), Prospective Studies, SARS-CoV-2 , Vaccination , Safe surgery, COVID-19/epidemiology, SARS-CoV-2 ; vaccination ; safe surgery, case fatality rate, Vaccination, Adolescent; Adult; Aged; COVID-19; COVID-19 Vaccines; Comorbidity; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Period; Prospective Studies; SARS-CoV-2; Vaccination; Young Adult, health care policy, Elective Surgical Procedures, vaccination modelling, Preoperative Period, COVID-19; SARS-CoV-2; cancer; vaccination; outcome; mortality; infection; modelling, prospective study, Article, SARS-CoV-2, vaccination, SDG 3 - Good Health and Well-being, COVID-19 Vaccines/pharmacology, Humans, Vaccination/methods, human, Aged, Science & Technology, Elective Surgical Procedure, adult; aged; Article; cancer grading; cancer surgery; case fatality rate; computer assisted tomography; elective surgery; female; follow up; health care policy; human; incidence; infection rate; infection risk; major clinical study; male; middle aged; mortality; outcome assessment; phase 3 clinical trial (topic); preoperative care; prospective study; sensitivity analysis; seroprevalence; Severe acute respiratory syndrome coronavirus 2; vaccination; young adult; COVID-19; COVID-19 Vaccines; Comorbidity; Elective Surgical Procedures; Postoperative Complications; Preoperative Period; SARS-CoV-2; Vaccination; surgery., Cura preoperatòria, major clinical study, mortality, infection, Prospective Studie, incidence, Surgery, Postoperative Complication, Human medicine, 610 Medizin und Gesundheit, AcademicSubjects/MED00910, Settore MED/29 - CHIRURGIA MAXILLOFACCIALE, Settore MED/18 - CHIRURGIA GENERALE, computer assisted tomography, ESTUDOS PROSPECTIVOS, surgery, safe surgery, Postoperative Complications, sensitivity analysis, Severe acute respiratory syndrome coronavirus 2, preoperative care, Vacunació, seroprevalence, covid, Elective Surgical Procedures/methods, Middle Aged, COVID, vaccination, cancer grading, outcome, /dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being, SARS-CoV-2; vaccination; surgery, Female, Original Article, cancer surgery, AcademicSubjects/MED00010, Life Sciences & Biomedicine, Adult, COVID-19 Vaccines, Adolescent, international prospective cohort study, Postoperative Complications/prevention & control, infection rate, SARS-CoV-2/immunology, NO, modelling, Young Adult, follow up, cancer, infection risk, outcome assessment, LS7_4, SARS-CoV-2, Preoperative care, COVID-19, 3126 Surgery, anesthesiology, intensive care, radiology, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], elective surgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Microsoft Academic Graph classification: Case fatality rate Medicine education.field_of_study Vaccination Cohort study medicine.medical_specialty Elective surgery education Prospective cohort study Incidence (epidemiology) Population business.industry Number needed to vaccinate Emergency medicine business
Dewey Decimal Classification: ddc:610
22 references, page 1 of 3
1. Whitaker IS, Fowler AJ, Dobbs T, Wan Y, Laloo R, Hui WSS et al. Resource requirements for reintroducing elective surgery in England during the COVID-19 pandemic: a modelling study. Br J Surg 2020;108:97-103.
2. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020;107:1440-1449. [OpenAIRE]
3. O'Reilly-Shah VN, Van Cleve W, Long DR, Moll V, Evans FM, Sunshine JE et al. Impact of COVID-19 response on global surgical volumes: an ongoing observational study. Bull World Health Organ 2020;98:671-682.
4. COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020;107:1097-1103.
5. Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PBS et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020;107: 1250-1261. [OpenAIRE]
6. Spinelli A, Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg 2020;107:785-787.
7. Glasbey JC, Nepogodiev D, Simoes JFF, Omar O, Li E, Venn ML et al. Elective Cancer Surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: an international, multicenter, comparative cohort study. J Clin Oncol 2021;39:66-78. [OpenAIRE]
8. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARSCoV-2 infection: an international cohort study. Lancet 2020;396: 27-38.
9. Jonker PKC, van der Plas WY, Steinkamp PJ, Poelstra R, Emous M, van der Meij W et al. Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications, and thromboembolic events: a Dutch, multicenter, matched-cohort clinical study. Surgery 2021;169:264-274.
10. COVIDSurg Collaborative. Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic. Br J Surg 2020;108:88-96.
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- Federal University of Mato Grosso do Sul Brazil
- University of Trieste Italy
- University of Edinburgh United Kingdom
- University of Southern Denmark Denmark
- Aarhus University Denmark
- University of Palermo Italy
- University of Oxford United Kingdom
- Catholic University of the Sacred Heart Italy
- University of Catania Italy
- University of Antwerp Belgium
- University of Messina Italy
- University of Pisa Italy
- Alma Mater Studiorum University of Bologna Italy
- University of East Anglia United Kingdom
- University of Modena and Reggio Emilia Italy
- Radboud University Nijmegen Netherlands
- University of Ferrara Italy
- University of Birmingham United Kingdom
- RWTH Aachen University Germany
- University of Siena Italy
- Queen’s University Belfast United Kingdom
- Vita-Salute San Raffaele University Italy
- University of Brescia Italy
- University of Rome Tor Vergata Italy
- KU Leuven Belgium
- French Institute for Research in Computer Science and Automation France
- University of Augsburg Germany
- University of Padua Italy
- Sapienza University of Rome Italy
- Bezmialem Vakif University Turkey
- Vrije Universiteit Brussel Belgium
- University of Verona Italy
- University of Helsinki Finland
- University of Milano-Bicocca Italy
- Hasan Kalyoncu University Turkey
- University of Barcelona Spain
- University Federico II of Naples Italy
- UNIVERSITA DEGLI STUDI DELLA CAMPANIA LUIGI VANVITELLI Italy
Abstract 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.
The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous.