IMPACT OF BREAKTHROUGH COVID-19 ON VACCINATED ELECTIVE AND AMBULATORY COLORECTAL SURGERY PATIENTS

ABSTRACT

Purpose/Background: Hospitals and ambulatory surgery care centers had to adapt as the COVID-19 pandemic progressed. Elective surgeries were initially restricted. Protocols to test for COVID-19 fluctuated as elective surgeries resumed, patients were vaccinated, and variants increased infection rates. Hypothesis/Aim: Our study aims to look at the number of breakthrough cases of COVID-19 on vaccinated ambulatory patients and the impact this had on a single colorectal division at a large urban academic institution. Methods/Interventions: This is a retrospective comparative cohort study that studied 123 surgeries from July 2021-October 2021. Prior to August 16, 2021, elective and ambulatory surgeries at our institution did not require a negative COVID test for vaccinated patients. After that date, vaccinated patients still had to get tested 3-5 days before surgery in order to proceed. Our study evaluates a cohort of patients prior to that date and compares it to patients after that date to see if there were breakthrough infections in vaccinated patients, but also to see if this significantly affected the number of cancellations in our surgical division. Analysis was performed in Microsoft Excel and R. Results/Outcome(s) Amongst the two groups, there were equal distributions amongst sex, age, and type of operation scheduled. The majority were ambulatory anorectal cases. Of 123 surgeries, 89 (72%) were completed. The rest were canceled (16%), rescheduled (11%), or no-show (1%). Of the rescheduled surgeries, two were repeat patients, and one was a close contact of a COVID+ person. In the period before the August 16th cutoff, all of the patients canceled for reasons other than COVID-19, and four of them had negative COVID tests recorded. All of the patients (n=2, 6%) who tested positive with breakthrough infections after COVID vaccination occurred after the August 16th cutoff. They both had recorded vaccinations 3-6 months prior. Limitations: This is a small study based on a single division at an academic institution during a limited time period. Conclusions/Discussion: New York City's positive COVID test rate reached a nadir on July 14, 2021, at 1.51%. As people were vaccinated and establishments re-opened, the positivity rate increased, reaching a peak of 4.02% on August 14, 2021. In response to this, our institution required COVID testing to assess for breakthrough cases in vaccinated patients. Two of our vaccinated patients tested positive and had their elective surgeries canceled, a rate of 6%, double the average positivity rate in New York City during the same time period. While the impact of two cancellations may seem small, this study addresses the fact that the new testing policies did catch significant breakthrough infections. Furthermore, this study supports hospital policies that may seem damaging to the hospital's revenue in favor of public safety. Future studies will examine the patient factors related to breakthrough infections in a vaccinated surgery population.