Can we measure surgical resilience?

Prehabilitation, enhanced recovery after surgery, or both? A narrative review

“…A growing body of literature suggests that postoperative recovery is not a passive process and begins preoperatively. For instance literature on preoperative risk calculators/tools, 173 preoperative interventions, 162 and surgical resiliency 174 all suggest that key indicators of recovery (or delayed recovery) can be identified and optimised before surgery. For ERAS and other surgical research studies measuring recovery, we suggest that the preparation for recovery or the 'pre-surgery recovery phase' needs to be included.…”

Impact of Mental Health on General Surgery Patients and Strategies to Improve Outcomes

“…41 There is research that there are quantifiable, measurable biomarkers that can help to predict resilience, including, neuropeptide Y, testosterone, and dehydroepiandrosterone. 42,43 Rainey, et al, found that those with high resilience markers were less likely to show symptoms of depression at 12 months following surgeries for traumatic injuries, and those with low resilience markers were more likely to have depression symptoms. 44 Aggregating mental health data does pose challenges.…”

Who is the surgically resilient individual with traumatic spinal cord injury?

“…We have previously proposed a hypothesis that could test the utility of resilience biomarkers in the surgical context (31). Given the need for early decompressive surgery, and the importance of resilience in adjusting after SCI, identifying the surgically resilient individual with SCI could help streamline patients towards individualised recovery pathways.…”

“…Clearly both approaches are complimentary and can be integrated into a holistic post-surgical management of individuals with SCI. Realistic patient expectations managed through effective therapeutic relationships can reduce the magnitude of the initial stress stimulus and increase the likelihood of compliance (31).…”

“…A better understanding of which patients are likely to recover faster from surgery following SCI will enable improved selection protocols. Selecting resilient individuals for ERAS programs is therefore an important clinical objective that signals the future of surgical recovery (31). Likewise, less resilient individuals may be at risk of prolonged recovery, but the dose-response relationship is currently unknown.…”