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.

Trial registration: ClinicalTrials.gov NCT04509986.

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

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.