Association Between Coronavirus Disease 2019 Vaccination and Mortality After Major Operations.

Area of Science:

• Surgical outcomes research
• Infectious disease epidemiology
• Vaccinology

Background:

• Societal guidelines suggest delaying elective surgery for unvaccinated patients with preoperative COVID-19.
• The impact of COVID-19 vaccination on the infection-operation time risk is not well understood.

Purpose of the Study:

• To compare 90-day postoperative mortality in fully vaccinated patients with and without COVID-19.
• To compare mortality between vaccinated and unvaccinated patients with COVID-19.

Main Methods:

• National US multicenter retrospective cohort study (July 2021-October 2022).
• Included high-risk surgeries (general, vascular, orthopedic, neurosurgery, genitourinary).
• Used inverse probability treatment weighted propensity scores to analyze mortality within 90 days of surgery.

Main Results:

• Among 3401 vaccinated patients, 12.9% had COVID-19 within 8 weeks pre-operation.
• No significant difference in unadjusted or adjusted 90-day mortality between vaccinated COVID-19-positive and negative patients.
• Proximity of COVID-19 diagnosis to surgery did not increase mortality risk in vaccinated individuals.

Conclusions:

• Postoperative mortality risk is not elevated for vaccinated patients with COVID-19 undergoing high-risk surgery within 8 weeks of diagnosis.
• Vaccination may negate the increased surgical risk observed in unvaccinated COVID-19 patients.