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

Nepogodiev, Dmitri; Joana F, F Simoes; Elizabeth, Li; Glasbey, James; Picciochi, Maria; Sivesh, K Kamarajah; Gujjuri, Rohan; Bhangu, Aneel; Maryam, A; Mohammed, A Azab; Dratif, A Janjua; Mohammed, A Zahran; Areej, A Abdelaziz; Aamir, Junaid; Norhafiza Ab Rahman,; Islah Munjih Ab Rashid,; Muna Aba Zaid,; Abaalkhail, Muath; Ababneh, Adnan; Ababneh, Hazim; Ababneh, Laila; Ababneh, Roba; Rafael Abad Alonso,; Alfredo Abad Gurumeta,; Abad-Motos, Ane; Abaker, Mussab; Ryan Rainiel Abary,; Abass, Adam; Abate, Emmanuele; Sheraz Abayazeed Ahmed,; Abayomi, Olukayode; Abazeed, Alaa; Abbad, Bader; Abbadessa, Francesco; Abbadi, Osaid; Abbakar, Malaz; Ahmed, M Abbas; Alzhraa Salah Abbas,; Abbas, Asad; Aya, M Abbas; Ferial Mohamed Ali Abbas,; Abbas, Jihad; Abbas, Manzar; André, Benoît; Andreani, Lorenzo; Andreani, Stefano; Andreatta, Erika; Andrejevic, Predrag; Andreotti, Isis; Ainhoa Andres Imaz,; Conrado Andrés Ros,; Eva Andreu Riobello,; Andrews, Emmet; Andrews, Kiah; Andriamanana, Liantsoa; Andrianakis, Alexandros; Herimampionona, E Andriantsoa; Andro, Christophe; Androus, Farah; Iván Andújar Lara,; Ikenna Anderson Aneke,; Anesi, Alexandre; Anesti, Katerina; Angeli Anne Ang,; Ang, Keng-Leong; Ang, Wei-Wen; Angel, Carol; Gustavo Adolfo Angel,; Martina Aida Angeles,; Angelico, Roberta; Angelides, Sophia; Angelis, Fragkiskos; Angelou, Dimitrios; Angelou, Kyveli; Angenete, Eva; Angerer, Rafael; Angermann, Reinhard; Francesc Angles Crespo,; Raquel Angulo Artal,; Anicetti, Joshua; Bankhead-Kendall, Brittany; Banks, Thomas; Bansal, Kuldeep; Bansal, Sujesh; Banting, Simon; Anas Bany Issa,; Hammam Bany Yasin,; Banziger, Carina; Baquedano, Mai; Baquero, David; Sergiu Catalin Baraian,; Barakat, Ahmed; Jamile Barakat Awada,; Baraket, Oussama; Baral, Perel; Baran, Elif; Barat, Maxime; Baratte, Baratte; Barauskas, Vidmantas; Barbara, Frezza; Barbas, Andrew; Barbato, Giuseppe; Barberá, Rafael; Barberio, Cristina; Barberis, Andrea; Barbier, Luis; Francisco José Barbosa Camacho,; Barbosa-Breda, Joao; Barca, Ida; Indalecio Barcelata Rodriguez,; Jose Carlos Barcelon,; Bárcena, Elizabeth; Bardelli, Laura; Bareka, Metaxia; Barillas, Kathia; Barillas, Sabrina; Barisic, Goran; Barišić, Tatjana; Barker, John; Barker, Jonathan; Barkhatov, Sergey; Bridgman, Elsie; Brienze, Carolina; Bright, Tim; Brignall, Rhiannon; Muhamad Zakaria Brimo Alsaman,; Brincat, Svetlana; Briner, Lukas; Brinkler, Rebecca; Brinskelle, Petra; Edulfo Britez Barrios,; Brito, Kattiucy; Francisca Brito da Silva,; Britos, Analia; Brits, Tim; Britton, John; Britton-Zier, Linda; Brivio, Ariberto; Brixton, Genevieve; Brkic, Lucija; Broadbent, Samuel; Brobbey, Phoebe; Broe, Claire; Broecheler, Tobias; Broglia, Alessandro; Brolese, Alberto; Brolo, Estuardo; Bromage, Stephen; Brooke-Smith, Mark; Peiman Brouki Milan,; Brown, Allison; Brown, Andrew; Brown, Benjamin; Elena Campos Carot,; Juan Campos Garcia,; Denisse Idalia Campos Mejía,; Campuzano, Nicolás; Borja Campuzano Bitterling,; Camuera, Maite; MªPilar Canals Sin,; Candan, Mert; Nipseey Pauloe Candelario,; Francisco Vidal Candia,; Candiani, Massimo; Candotti, Giorgio; Ruben Canelo Professor,; Cankoski, Dalibor; Virginia Cano Busnelli,; Jorge Caño Velasco,; Cano-Trigueros, Emiliano; Canonico, Giuseppe; Canotilho, Rita; Canovic, Samir; Cantero, Daniel; Ruano, Ana; Adriana Ruano Campos,; Rubbini, Michele; Rubbo, Sonia; Rubiano, Wilson; Rubicz, Nina; Rubio, Enrique; Mercedes Rubio Manzanares Dorado,; Rubio-Palau, Josep; Rubio-Perez, Ines; Occhionorelli, Savino; Feo, Carlo; Yu, Angeli Christy

doi:10.1093/bjs/znab101

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.