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

COVIDSurg Collaborative, GlobalSurg Collaborative

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.

Trial registration: ClinicalTrials.gov NCT04509986.

© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Figures

Fig. 1
Fig. 1
Global number needed to vaccinate to prevent one COVID-19-related death over 1 year Number needed to vaccinate estimates for the general population are based on global SARS-CoV-2 infection rates (26.48 per million people per day); estimates assume that this remains steady for a full year. For surgical patients, estimates are based on preoperative vaccination. Error bars indicate estimates for best- and worst-case scenarios. Data are presented on a logarithmic scale.
Fig. 2
Fig. 2
Estimates for number needed to vaccinate to prevent one COVID-19-related death over 1 year, based on country-specific SARS-COV-2 community infection rates, stratified by age a 18–49 years, b 50–69 years, and c 70 years or more. Number needed to vaccinate is plotted on a logarithmic scale.

References

    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
    1. 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
    1. 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
    1. COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020;107:1097–1103
    1. 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
    1. Spinelli A, Pellino G.. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg 2020;107:785–787
    1. 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
    1. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020;396:27–38
    1. 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
    1. 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
    1. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R. et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 2021;384:403–416
    1. Logunov DY, Dolzhikova IV, Zubkova OV, Tukhvatulin AI, Shcheblyakov DV, Dzharullaeva AS. et al. Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: two open, non-randomised phase 1/2 studies from Russia. Lancet 2020;396:887–897
    1. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S. et al.; C4591001 Clinical Trial Group. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020;383:2603–2615
    1. Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK. et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 2021;397:99–111
    1. So AD, Woo J.. Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis. BMJ 2020;371:m4750.
    1. Economist Intelligence Unit. Coronavirus Vaccines: Expect Delays. Q1 Global Forecast 2021. (accessed 1 February 2021)
    1. O'Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J. et al. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature 2020;590:140-145.
    1. Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N. et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis 2020;20:669–677
    1. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430–436
    1. BUPA. Schedule of Procedures. (accessed 20 August 2020)
    1. Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Macdonald B. et al. Coronavirus Pandemic (COVID-19). (accessed 11 January 2021)
    1. Joint Committee on Vaccination and Immunisation. Advice on Priority Groups for COVID-19 Vaccination. (accessed 28 January 2021)

Source: PubMed

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