title: Surgical resilience: a review of resilience biomarkers and surgical recovery.
abstract: BACKGROUND
  Two distinct and large bodies of literature exist on resilience that are of potential interest for surgical outcomes. First is the literature on the impact of resilience on surgical recovery and wound-healing. Second is the literature on biomarkers for resilience, which largely focuses on neuropeptide Y (NPY), testosterone and dehydroepiandrosterone (DHEA). Despite this activity, there is a dearth of literature linking these two bodies of research by investigating biomarkers for surgical resilience and its impact on surgical recovery. This paper reviews both bodies of literature within the context of surgical recovery.
  
  
  METHODS
  Literature searches within Medline and Embase were conducted for studies and previous reviews of resilience biomarkers and for the impact of individual resilience on surgical recovery. Reference lists of the reviews were searched for additional papers. No systematic review is yet possible due to the novelty of the use of resilience biomarkers within a surgical context.
  
  
  RESULTS
  This is the first review to explore a potential link between resilience biomarkers and surgical recovery. There are a number of biomarkers that correlate with individual resilience levels and resilient individuals exhibit better recovery trajectories following surgery, suggesting a novel use of such biomarkers for the identification of "surgical resilience".
  
  
  CONCLUSIONS
  By identifying surgical resilience, there is potential for utilising these biomarkers as prognostic indicators of likely recovery trajectories from surgery, which in turn complement individualised peri-operative management.
authors.affiliation: Department of Surgery, Concord Repatriation General Hospital, Australia; Faculty of Medicine, University of Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Graham
authors.affiliation: Department of Surgery, Concord Repatriation General Hospital, Australia. Electronic address: guillermo.becerril@sswahs.nsw.gov.au.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Becerril-Martinez
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D015415:Biomarkers / Q000032:analysis* / Q000097:blood; D003289:Convalescence / Q000523:psychology; D003687:Dehydroepiandrosterone / Q000097:blood; D006801:Humans; D009478:Neuropeptide Y / Q000032:analysis; D020127:Recovery of Function / Q000502:physiology*; D055500:Resilience, Psychological; D013312:Stress, Physiological / Q000502:physiology; D013514:Surgical Procedures, Operative / Q000523:psychology / Q000534:rehabilitation*; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D014947:Wounds and Injuries / Q000097:blood / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D009478:Neuropeptide Y; D013739:Testosterone; D003687:Dehydroepiandrosterone
keywords: Adaptation; Biological markers; Resilience; Stress; Surgery; Treatment outcome