COVID-19 Vaccination Associated With Reduced Postoperative SARS-CoV-2 Infection and Morbidity

Abstract

Objective: The purpose of this study was to determine the effect of COVID-19 vaccination on postoperative mortality, pulmonary and thrombotic complications, readmissions and hospital lengths of stay among patients undergoing surgery in the United States. Background: While vaccination prevents COVID-19, little is known about its impact on postoperative complications. Methods: This is a nationwide observational cohort study of all 1,255 Veterans Affairs facilities nationwide. We compared patients undergoing surgery at least 2 weeks after their second dose of the Pfizer BioNTech or Moderna vaccines, to contemporary propensity score matched controls. Primary endpoints were 30-day mortality and postoperative COVID-19 infection. Secondary endpoints were pulmonary or thrombotic complications, readmissions, and hospital lengths of stay. Results: 30,681 patients met inclusion criteria. After matching, there were 3,104 in the vaccination group (1,903 received the Pfizer BioNTech, and 1,201 received the Moderna vaccine) and 7,438 controls. Full COVID-19 vaccination was associated with lower rates of postoperative 30-day COVID-19 infection (Incidence Rate Ratio and 95% confidence intervals, 0.09 [0.01,0.44]), pulmonary complications (0.54 [0.39, 0.72]), thrombotic complications (0.68 [0.46, 0.99]) and decreased hospital lengths of stay (0.78 [0.69, 0.89]). Complications were also low in vaccinated patients who tested COVID-19 positive before surgery but events were too few to detect a significant difference compared to controls. Conclusion: COVID-19 vaccination is associated with lower rates of postoperative morbidity. The benefit is most pronounced among individuals who have never had a COVID-19 infection before surgery.

Partial COVID-19 vaccination associated with reduction in postoperative mortality and SARS-CoV-2 infection

“…In addition to confirming our previous report, which noted that two doses of mRNA vaccine were associated with a lower rate of pulmonary failure compared to no vaccination, 7 the current report finds that being partially vaccinated is associated with reduction in the rates of pulmonary failure. Given the reduction in mortality rates associated with being partially vaccinated, it is possible that there are other systemic benefits to SARS-CoV-2 viral mRNA exposure through vaccination.…”

“…6 We have previously shown data that mRNA vaccines against SARS-CoV-2 are associated with reduced rates of postoperative COVID-19 and pulmonary complications. 7 However, there are no data comparing the effectiveness of being fully vaccinated vs. partially vaccinated. Patients and surgeons have no guidance on whether the risks associated with delaying surgical procedures are outweighed by the benefits of waiting the recommended two weeks after the second dose of vaccination to allow for maximum immune protection.…”

Stuck between a rock and a hard place: The clinical conundrum of managing cardiac surgical patients during the SARS‐CoV‐2 pandemic

“…A recent analysis of over 10,000 surgical patients demonstrated a significant reduction in postoperative COVID-19 infections, as well as pulmonary and thrombotic complications, amongst those vaccinated against COVID-19 compared with those unvaccinated. 14 In summary, Bonalumi et al have provided further evidence that confirms the significant additional risk perioperative COVID-19 infection confers to patients undergoing cardiac surgery. While balancing the risk of COVID-19 infection with the risk of deferring major cardiovascular surgery remains a dilemma for surgeons internationally, emerging evidence suggests that the solution may lie in continuing advocacy and education surrounding COVID-19 vaccination.…”

“…Perhaps no solution has been more promising, however, than COVID‐19 vaccination. A recent analysis of over 10,000 surgical patients demonstrated a significant reduction in postoperative COVID‐19 infections, as well as pulmonary and thrombotic complications, amongst those vaccinated against COVID‐19 compared with those unvaccinated 14 …”

Timing of surgery following SARS‐CoV‐2 infection: an ever‐changing landscape

“…Many countries have been fortunate to have widespread availability and uptake of vaccines, and we know that the vaccinated are less likely to have severe symptoms or require hospitalisation when compared with the unvaccinated [ 3 ]. At present, there is limited evidence regarding postoperative mortality rates in vaccinated patients with a peri‐operative diagnosis of SARS‐CoV‐2 infection compared with those who are unvaccinated, and we lack evidence regarding mortality rates for vaccinated patients undergoing elective surgery in the weeks following a diagnosis of SARS‐CoV‐2 infection [ 4 ]. It is plausible that vaccination may offer some protection from the excess mortality associated with undergoing surgery in the 7 weeks after a diagnosis of SARS‐CoV‐2 given that it can mitigate the severity of acute infection.…”