There were no significant differences in rates of postoperative pulmonary complications (29 versus 34 per cent P = 0.208) or 30-day mortality (10 versus 14 per cent P = 0.221), on adjusted analysis ( Tables S5 and S6). Stratified analysis performed by timing of vaccination demonstrated that patients who were vaccinated 15 years previously or longer were less likely than patients vaccinated less than 15 years ago to be ASA grades III–V (30 versus 41 per cent P = 0.033) and were more likely to have surgery for benign disease (72 versus 57 per cent P < 0.001) ( Table S4). OR, odds ratio BCG, Bacillus Calmette-Guérin REF, referent.
#STEFAN KAISER ESSENTIA FULL#
Full models are presented in Tables S2 and S3. There were no significant differences in 30-day mortality rates in previously BCG-vaccinated patients versus unvaccinated patients (10 versus 13 per cent P = 0.062), which remained on adjusted analysis (OR 1.25, 95 per cent c.i. Although rates of PPC were significantly lower in patients who had previously been vaccinated against BCG than those who did not (29 versus 38 per cent P < 0.001) ( Table 1), this did not persist on adjusted analysis (odds ratio (OR) 0.98, 95 per cent c.i.
The 30-day mortality was 11.1 per cent ( n = 265). Of the 2391 patients, 759 (31.7 per cent) developed PPC. There were no significant differences in the rates of emergency surgery, major surgery, or timing of SARS-CoV-2 infection between the groups.
Patients who had received a BCG vaccination were younger than patients who had not been vaccinated (70 years of age or older: 16 versus 35 per cent ( P < 0.001)), had lower ASA (grades III–V: 30 versus 51 per cent ( P < 0.001)), and were more likely to have surgery for benign conditions (71 versus 60 per cent P < 0.001). The BCG vaccine had been administered to 1649 (69.0 per cent) patients, of whom 1518 (63.5 per cent) had received it at least 15 years before surgery. Overall, 1165 (48.9 per cent) patients were male and 524 (21.9 per cent) were aged 70 years or older ( Table S1). This study included 2391 patients from 428 hospitals across 64 countries from February 2020 to July 2020. The full methodology is available in the Appendix S2. A logistic regression model was used to find the odds of association.
These were compared in patients with and without BCG vaccination.
The primary outcome was the rate of 30-day PPC and the secondary outcome was 30-day postoperative mortality rate. This COVIDSurg study 3–5 was an international prospective cohort study that included patients who had surgery between 1 February and 31 July 2020 and were diagnosed with SARS-CoV-2 within 7 days before or 30 days after surgery. Owing to the uncertainty on the role of BCG vaccine on the outcomes of patients with perioperative SARS-CoV-2 infection, this international study aimed to determine whether previous BCG vaccination was associated with reduced postoperative pulmonary complications (PPC) and 30-day mortality in patients undergoing surgery who developed SARS-CoV-2 infection. There was, however, no evidence supporting or disputing this theory 1, 2. During the COVID-19 pandemic, multiple theories were proposed based on the observation that countries with an ongoing national Bacillus Calmette-Guérin (BCG) immunization programme had lower SARS-CoV-2 case rates and COVID-19 mortality than countries that had stopped BCG vaccine administration.
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