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Patients undergoing elective surgery should be prioritized for COVID-19 vaccination over the general population, a global modeling study suggested.

Such a policy could avert over 56,000 deaths from COVID-19 worldwide, reported the , a multi-national group of surgeons and anesthetists in more than 80 countries.

Older patients requiring cancer surgery would gain the most benefit, the team wrote in the .

"Preoperative vaccination could support a safe re-start of elective surgery by significantly reducing the risk of COVID-19 complications in patients and preventing tens of thousands of COVID-19-related post-operative deaths," said co-author Aneel Bhangu, PhD, of the University of Birmingham in England, in a statement.

The researchers added that patients who develop COVID-19 infection are at a four- to eight-fold increased risk of death within 30 days of surgery, and that a patient over age 70 requiring cancer surgery would usually have a 2.8% mortality rate, but that rises to 18.6% if patients have COVID-19.

The authors said that elective surgeries may be cancelled or postponed once again if waves of COVID-19 persist throughout 2021, and hypothesized that prioritizing this population for vaccination could even decrease post-operative pulmonary complications, ICU use, and overall healthcare costs.

For this analysis, Bhangu and colleagues examined data from the GlobalSurg-COVIDSurg study, spanning nearly 1,700 hospitals in 116 countries. Overall, 56,589 patients were included. Post-operative SARS-CoV-2 positivity was 0.96%. Adjusted analyses also showed a significant association between COVID-19 infection and 30-day post-operative mortality.

The researchers derived their estimates from post-operative SARS-CoV-2 rates and mortality in an international cohort of surgical patients as compared with SARS-CoV-2 incidence and case fatality data in the general population.

Numbers needed to vaccinate to prevent one COVID-related death in one year were 1,840 for the general population but only 351 for patients ages 70 and older undergoing cancer surgery.

And numbers needed to vaccinate to prevent one COVID-19 related death over 30 days were 425 among patients ages 70 and older needing cancer surgery versus 22,384 for the general population.

"Implementation of vaccination for surgical patients will require the development of preoperative pathways to deliver vaccination ahead of planned surgery dates," the authors wrote. "These pathways should be designed alongside wider system developments aimed at reducing nosocomial SARS-CoV-2 transmission, such as preoperative SARS-CoV-2 swab testing and COVID-free surgical pathways."

The group noted that these estimates "should be interpreted with caution," and will fluctuate with COVID-19 prevalence. In addition, since this was a global study, its regional applicability may be limited. And, the researchers said, case fatality rates were based on data from England, and vaccine efficacy rates were based on clinical trials, not effectiveness in surgical patients specifically.

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