Association for Academic Surgery (AAS)

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Educating Our Preoperative Surgical Patients with Respect to COVID-19 Vaccination

Virtually all major medical centers in the United States strongly encourage or require COVID-19 vaccination for health care providers.  Additionally, COVID-19 vaccination is approved and encouraged for all Americans 5 years or older.  According to the Center for Disease Control (CDC), as of this blog post, approximately 60% of the US population are fully vaccinated (Ref 1).  The absence of relevant vaccine education or exposure to disinformation are prominent among the many reasons cited for vaccine hesitancy (Ref 2).  As surgeons, we play an important role in helping educate our patients and empowering them to make the right decision with respect to reducing their risk of acquiring and transmitting COVID-19.  The need to visit a surgeon is often accompanied by a willingness to listen to and act upon sound medical advice.  Our pre- and post-operative visits are important opportunities to offer thoughtful, personalized education regarding COVID-19 vaccination in a private setting.  Providing sound medical advice in a clinic room when a patient is surrounded only by their most trusted care partner may be an effective strategy to improve compliance with the recommendation to accept the vaccine.  For this reason, I have listed a few of the reasons my patients previously chose not to get vaccinated, and I have included suggestions on how to address their stated concerns or objection:

  • Lack of trust: Patients may trust their surgeon to perform complex surgical procedures, but do not trust their advice with respect to COVID vaccination.  An honest acknowledgment that we are not infectious disease experts can be followed up by pointing out that our medical education is very broad, and that almost 2 years into the COVID-19 pandemic we have all learned volumes about how to care for infected patients, and how to reduce the risk of infection.  Keep printed material from reputable sources in easy-to-understand language available (such as the CDC link). Consider having materials in other languages commonly spoken by your clinic population available as well.

 

  • Lack of vaccine availability: Work with your hospital administration and pharmacy team to facilitate easy of same-day vaccine administration in surgical clinic spaces.  If your clinic cannot provide this service, consider retraining and designating a patient navigator who can visit individual clinic patient rooms to give personalized information about where and how to get vaccinated.  Again, the CDC is an excellent resource (Ref 1).

 

  • Not enough time before the operation to complete a 2-shot vaccine series: When feasible, non-urgent operations can be scheduled at least 2 weeks after the initial clinic visit to allow for a single-dose Johnson & Johnson vaccine dose which confers substantial protection against life-threatening COVID-19 infection.  The ENSEMBLE trial included 43,783 adults and demonstrated that a single dose of the J&J/Janssen vaccine prevented nearly 66.9% of moderate to severe-critical COVID-19 cases after 14 days, and prevented 100% of people with severe COVID-19 from needing to go to the hospital for treatment (Ref 3).

 

  • Potential consequences of COVID-19 infection: Educate the patient on the potential impact of perioperative COVID-19 infection given the individual patient’s comorbidities and planned operation.  In cancer patients, this conversation should also include the potential for neoadjuvant or adjuvant systemic therapies that could weaken the patient’s immune system and leave them even more vulnerable to severe COVID-19 infection and death.

 

  • Avoidance of the preoperative nasal swab: Perhaps it’s a fear of needles that is the barrier to COVID-19 vaccination.  The typical alternative to preoperative vaccination is a PCR test via nasal swab.  For many, a properly performed nasopharyngeal swab procedure can be equally if not more uncomfortable.  Describe to patients that a single-dose Johnson & Johnson vaccine dose could be their ticket out of an uncomfortable nasopharyngeal swab.

 

For patients who are already vaccinated, encourage your patient to consider receiving a COVID-19 booster shot.  A large study conducted in Israel showed that a Pfizer-BioNTech booster administered after 2 vaccine doses resulted in a 90% reduction in the risk of death compared to patients who did not receive a booster (Ref 4).

Hopefully, these suggestions are effective in helping you educate your patients and their care partners.  If you are successful in helping your patient reach a decision to receive COVID-19 vaccination then consider suggesting that they also receive the annual influenza vaccination (simultaneous or staged).  As healthcare providers and as surgeons, we play an important role in protecting our patients and our community through thoughtful, timely, and reliable communication regarding all methods of controlling COVID-19 transmission, including vaccination.

References

  1. “COVID-19 Vaccinations in the United States”, Center for Disease Control, https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total. Accessed December 9, 2021.
  2. Hughes, Brian et al. “Development of a Codebook of Online Anti-Vaccination Rhetoric to Manage COVID-19 Vaccine Misinformation.” International Journal of Environmental Research and Public Health14 (2021): 7556.
  3. Sadoff, Jerald, et al. “Safety and efficacy of single-dose Ad26. COV2. S vaccine against Covid-19.” New England Journal of Medicine23 (2021): 2187-2201.
  4. Arbel, Ronen et al. “BNT162b2 Vaccine Booster and Mortality Due to Covid-19.” New England Journal of Medicine, 10.1056/NEJMoa2115624. 8 Dec. 2021, doi:10.1056/NEJMoa2115624
Carlo Contreras

Carlo Contreras

Dr. Carlo M. Contreras is an Associate Professor of Surgery at The Ohio State University Comprehensive Cancer Center. He serves as Associate Program Director for the OSU Complex General Surgical Oncology Fellowship. His clinical and research interests include immunotherapy for cutaneous malignancies and the use of non-invasive devices for monitoring lymphedema.