Immune Phenotype and Postoperative Complications after Elective Surgery

Dimitrios Moris, Richard Barfield, Cliburn Chan, Scott Chasse, Linda Stempora, Jichun Xie, Jennifer K. Plichta, Julie Thacker, David H. Harpole, Todd Purves, Sandhya Lagoo-Deenadayalan, Eun Sil Shelley Hwang, Allan D. Kirk

Research output: Contribution to journalArticlepeer-review


Objectives: To characterize and quantify accumulating immunologic alterations, pre and postoperatively in patients undergoing elective surgical procedures. Background: Elective surgery is an anticipatable, controlled human injury. Although the human response to injury is generally stereotyped, individual variability exists. This makes surgical outcomes less predictable, even after standardized procedures, and may provoke complications in patients unable to compensate for their injury. One potential source of variation is found in immune cell maturation, with phenotypic changes dependent on an individual's unique, lifelong response to environmental antigens. Methods: We enrolled 248 patients in a prospective trial facilitating comprehensive biospecimen and clinical data collection in patients scheduled to undergo elective surgery. Peripheral blood was collected preoperatively, and immediately on return to the postanesthesia care unit. Postoperative complications that occurred within 30 days after surgery were captured. Results: As this was an elective surgical cohort, outcomes were generally favorable. With a median follow-up of 6 months, the overall survival at 30 days was 100%. However, 20.5% of the cohort experienced a postoperative complication (infection, readmission, or system dysfunction). We identified substantial heterogeneity of immune senescence and terminal differentiation phenotypes in surgical patients. More importantly, phenotypes indicating increased T-cell maturation and senescence were associated with postoperative complications and were evident preoperatively. Conclusions: The baseline immune repertoire may define an immune signature of resilience to surgical injury and help predict risk for surgical complications.

Original languageEnglish
Pages (from-to)873-882
Number of pages10
JournalAnnals of surgery
Issue number6
StatePublished - 1 Dec 2023
Externally publishedYes


  • immune phenotypes
  • postoperative outcomes
  • surgery
  • surgical injury


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