Secrets of the perioptome: new tools for a new concept.
OBJECTIVE
The field of perioperative genomics is developing rapidly, and by now most practitioners are familiar with the idea that the host response to surgery and trauma is at least in part genetically determined. The precise way in which genetic variation affects outcomes after injury and surgical treatment is not known however. This review considers recent advances in thinking in the domain of perioperative genomics.


RESULTS
Genome wide association studies (GWAS) have been conducted in tens of thousands of patients at enormous cost, using phenotypes of varying complexity and clarity. Despite this massive investment, we are still unable to explain a majority of the observed heritability of most complex traits, such as the response to surgery. Recently, attention has turned to deep resequencing of candidate genes, as a precursor to the era of the individual genome.


CONCLUSIONS
GWAS have not delivered the expected answers to the question 'how does our genome determine our response to illness and its treatment?' There is a new, postgenomic, era dawning, and perioperative scientists are now well positioned to further explore the perioptome--the space where the genome, the operating room, and the ICU intersect.
Shaw
Andrew
A
Department of Anesthesiology, Durham Veterans Affairs Medical Center, Duke University Medical Center, Durham, North Carolina, USA.
VandeVen
Thomas
T
D001827:Body Height / Q000235:genetics; D019295:Computational Biology; D003920:Diabetes Mellitus / Q000235:genetics; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D055106:Genome-Wide Association Study; D023281:Genomics; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D040901:Proteomics; D012307:Risk Factors