PATIENTS awaiting scheduled surgery should be vaccinated against Covid 19 before the operation, to avoid thousands of potential post-operative deaths linked to the virus globally. Especially in low-income countries, where it is more difficult to guarantee Covid free in-hospital pathways and the rigorous application of Sars-CoV-2 infection mitigation strategies. It is the conclusion of a study published on BJS, British journal of surgery conducted by an international team of researchers who belong to the Covid Surg Collaborative, the research network that includes 5,000 experts from about 130 countries, whose results were obtained on the basis of data relating to 141,582 patients from 1,667 hospitals in 116 countries, including which ours.
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I study
The survey, which was funded by the NIHR, the UK’s National Institute for Health Research and coordinated by the University of Birmingham, found that between 0.6% and 1.6% of patients develop a Covid infection. -19 after a scheduled surgery. And that these patients have a 4 to 8 times greater risk of death than the general population, in the 30 days following the operation. An example: while patients over 70 who undergo surgery for a tumor normally have a mortality rate of around 2.8%, this percentage rises to 18.6% if these patients develop a Covid-19 infection. Scientists have calculated that by vaccinating those who have surgery scheduled before surgery, they are more likely to avoid Covid-related deaths19 than those that can be prevented by vaccinating the general population. And that this is especially true for the over 70s and for those who have to have cancer surgery: in fact, while in the general population, to save a life in a year, 1,840 people aged 70 or over need to be vaccinated to obtain the same result. In other words, one life saved, it is sufficient to vaccinate 351 surgical patients. Overall, the authors estimated that giving priority to preoperative vaccination could prevent an additional 58,687 deaths related to Covid-19 in one year, globally.
Low and middle-income countries
Here, all of this is particularly interesting for low- and middle-income countries where mitigation measures are less likely to be universally implemented that reduce the risk of virus-related complications, such as nasal swab screening, and covid-free surgical pathways. “Preoperative vaccination could facilitate a safe restart of elective surgery (scheduled, ed) by significantly reducing the risk of complications from covid-19 in patients and preventing tens of thousands of post-operative deaths related to covid – said Aneel Banghu of the University. of Birmingham and co-author of the paper. “Vaccine supplies are limited and governments are prioritizing vaccination for groups at highest risk of covid-19 mortality, our work can help make these decisions,” he said. added Bhangu.
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A global priority
“The restart of elective surgery is a global priority – said Dmitri Nepogodiev, of the University of Birmingham, also co-author of the publication – It is crucial that policy makers use the data we have collected to support a safe restart of elective surgery. , vaccination against covid should be a priority for patients undergoing elective surgery ”.
Surgery during the pandemic. What happened in the world …
A study published last May always on British Journal of Surgey had estimated that during the first wave of the pandemic up to 70% of elective surgeries were postponed, and 28 million procedures globally were canceled or delayed. Quest the numbers. But the meaning? What does delaying or postponing surgery mean for patients? “In the case of non-oncological interventions, a worsening of the quality of life and an extension of the waiting lists. For those oncology it means getting to the resection of a tumor when the disease is at a more advanced stage which can lead to a worse prognosis and therefore a lower survival. And that is what we are seeing: we are seeing cases of more advanced cancers arriving in the operating room than in previous years, “he says. Solomon Di Xavier, adjunct professor of General Surgery at the Insubria University, head of Surgery I at the Circolo di Varese hospital, and member of the committee that coordinated the COVIDSurg study for Italy together with Francesco Pata, Gaetano Gallo, Marco Fiore e Gianluca Pellino.
… And in Italy
“During and due to the pandemic, Italian surgery, with varying differences depending on the region, suffered major delays. Now we are recovering, once again patchy, following the fluctuations of the pandemic in the different areas of the peninsula ”, adds Di Saverio. “Surgical patients should be vaccinated because they are fragile twice, especially elderly and cancer patients – concludes the surgeon – because if they fall ill with covid after the operation, they are more likely to die than others, and because if they are not operated on, for reasons of security, they will have a worse prognosis. The data processed for Italy show that the rate of Sars-COV-2 infection within 30 postoperative days among patients recruited in the 115 Italian centers that participated in the study was 1.8% with a significantly higher risk, 2.4%, in cancer surgical patients compared to patients with other pathologies, 1.4% “.
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