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Original Research |

Safety of Seasonal Influenza Vaccination in Hospitalized Surgical Patients: A Cohort StudySafety of Seasonal Influenza Vaccination in Hospitalized Surgical Patients

Sara Y. Tartof, PhD; Lei Qian, PhD; Gunter K. Rieg, MD; Kalvin C. Yu, MD; Lina S. Sy, MPH; Hung Fu Tseng, PhD; Rulin C. Hechter, MD, PhD; and Steven J. Jacobsen, MD, PhD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 15 March 2016.


From Kaiser Permanente Southern California Department of Research & Evaluation and Southern California Permanente Medical Group, Pasadena, California.

Note: Drs. Tartof and Qian had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Acknowledgment: The authors thank S. Michael Marcy for invaluable contributions to the development of this study and Cheryl Mercado, who contributed significant technical assistance to this project.

Financial Support: This study was funded through the Vaccine Safety Datalink under contract 200-2012-53580 from the Centers for Disease Control and Prevention.

Disclosures: Dr. Tartof reports grants from the Centers for Disease Control and Prevention during the conduct of the study and grants from Merck outside the submitted work. Dr. Qian reports grants from the Centers for Disease Control and Prevention during the conduct of the study. Dr. Yu reports grants from the Centers for Disease Control and Prevention during the conduct of the study. Dr. Tseng reports grants from Novartis and GlaxoSmithKline outside the submitted work. Dr. Hechter reports grants from Novartis and GlaxoSmithKline outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=M15-1667.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

Reproducible Research Statement:Study protocol: Available from Dr. Tartof (e-mail, sara.y.tartof@kp.org). Statistical code: Available in the Appendix or from Dr. Qian (e-mail, lei.x.qian@kp.org). Data set: Not available.

Requests for Single Reprints: Sara Y. Tartof, PhD, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd Floor, Pasadena, CA 91101.

Current Author Addresses: Drs. Tartof, Qian, Rieg, Yu, Tseng, Hechter, and Jacobsen and Ms. Sy: Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101.

Author Contributions: Conception and design: S.Y. Tartof, L. Qian, G.K. Rieg, K.C. Yu, L.S. Sy, H.F. Tseng, R.C. Hechter, S.J. Jacobsen.

Analysis and interpretation of the data: S.Y. Tartof, L. Qian, K.C. Yu, L.S. Sy, H.F. Tseng, R.C. Hechter, S.J. Jacobsen.

Drafting of the article: S.Y. Tartof, K.C. Yu, H.F. Tseng.

Critical revision of the article for important intellectual content: S.Y. Tartof, L. Qian, G.K. Rieg, L.S. Sy, H.F. Tseng, R.C. Hechter, S.J. Jacobsen.

Final approval of the article: S.Y. Tartof, L. Qian, G.K. Rieg, K.C. Yu, L.S. Sy, H.F. Tseng, R.C. Hechter, S.J. Jacobsen.

Statistical expertise: S.Y. Tartof, L. Qian, H.F. Tseng.

Obtaining of funding: S.Y. Tartof, L.S. Sy, S.J. Jacobsen.

Administrative, technical, or logistic support: S.Y. Tartof, L.S. Sy, S.J. Jacobsen.

Collection and assembly of data: S.Y. Tartof, L. Qian.


Ann Intern Med. 2016;164(9):593-599. doi:10.7326/M15-1667
© 2016 American College of Physicians
Text Size: A A A

Background: Despite recommendations to vaccinate surgical inpatients against influenza, vaccination rates remain low in this population, due in part to concerns about potential negative effects on postsurgical care.

Objective: To evaluate whether influenza vaccination in the perioperative period increases health care utilization and evaluations for postsurgical infection after discharge.

Design: Retrospective cohort study.

Setting: Members of Kaiser Permanente Southern California.

Participants: Patients aged 6 months or older who had inpatient surgery with admission and discharge between 1 September and 31 March from 2010 to 2013.

Measurements: All influenza vaccinations administered between 1 August and 30 April in the 2010–2011, 2011–2012, and 2012–2013 influenza seasons. Outcomes included rates of outpatient visits, readmission, emergency department (ED) visits, fever (temperature ≥38.0 °C), and clinical laboratory evaluations for infection (urine culture, complete blood count, blood culture, and wound culture) in the 7 days after discharge.

Results: Of the 42 777 surgeries included in adjusted analyses, vaccine was administered during hospitalization in 6420. No differences were detected between the vaccinated and unvaccinated groups in risk for inpatient visits (rate ratio [RR], 1.12 [95% CI, 0.96 to 1.32]), ED visits (RR, 1.07 [CI, 0.96 to 1.20]), postdischarge fever (RR, 1.00 [CI, 0.76 to 1.31]), or clinical evaluations for infection (RR, 1.06 [CI, 0.99 to 1.13]). A marginal increase in risk for outpatient visits (RR, 1.05 [CI, 1.00 to 1.10]; P = 0.032) was found.

Limitation: The study did not distinguish between planned and unplanned readmissions or outpatient visits.

Conclusion: No strong evidence of increased risk for adverse outcomes was found in comparisons of patients who received influenza vaccine during a surgical hospitalization and those who did not. The data support the recommendation to vaccinate surgical inpatients against influenza.

Primary Funding Source: Centers for Disease Control and Prevention.

Figures

Grahic Jump Location
Figure.

Comparison of standardized difference scores before and after IPTW.

ED = emergency department; IPTW = inverse probability of treatment weighting.

Grahic Jump Location

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