Metabolomics and Other “-Omic” Approaches to Characterize Perioperative Trajectories

Surgical trauma triggers a robust stress response which can exceed the body’s internal tolerances becoming the primary mechanism for further injury and perioperative organ dysfunction. However, postoperative patient trajectories and in particular the ability to maintain or recover appropriate function following controlled surgical trauma remain poorly described, lacking both a precise phenotypic framework and mechanistic understanding. A number of technologies have emerged that enable rapid quantification of metabolic states in biofluids and tissues using both targeted and unbiased metabolomic approaches and successfully used to characterize and gain mechanistic insight into patient responses to surgery, trauma, and critical illness, as well as predict recovery and long-term survival after surgery. A quantitative description of the dynamic patient state before and following surgical trauma in critical care settings using longitudinal metabolic and immunophenotyping offers the promise to refine preventative, monitoring, and therapeutic decisions informing surgical and perioperative decision-making.