title: Does major surgery induce immune suppression and increase the risk of postoperative infection?
abstract: OBJECTIVE
  Infection is the commonest cause of a postoperative complication. Following major surgery alterations in immune function are commonplace and these may contribute to an enhanced susceptibility to acquire nosocomial infections. This review will discuss postoperative infections in the context of an altered perioperative immune response and the factors influencing this response.
  
  
  RESULTS
  Up to 10% of patients undergoing elective in-patient surgery may develop a postoperative infection. Laboratory advances now permit systematic monitoring of single-cell immune signatures, which enable a clearer description of the interaction between tissue damage, immune modulation and clinical outcomes. Traditional candidate gene expression has identified pathways that define the detrimental immune modulating effects of perioperative allogeneic blood transfusion. Large clinical studies have demonstrated that the choice of anaesthetic technique may have an impact on postoperative infections through differential immune modulation.
  
  
  CONCLUSIONS
  Point of care tests are emerging that allow monitoring of the perioperative immune response. These could be further developed to introduce personalised care pathways. Consideration must also be given to anaesthesia techniques and perioperative treatments that may be associated with poor outcomes through immune modulation.
authors.affiliation: aCentre for Translational Medicine & Therapeutics, William Harvey Research Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK bAdult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK cCentre for Trauma Sciences, Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK.
authors.forename: Hew D T
authors.initials: HD
authors.lastname: Torrance
authors.forename: Rupert M
authors.initials: RM
authors.lastname: Pearse
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Dwyer
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D011183:Postoperative Complications / Q000453:epidemiology* / Q000276:immunology* / Q000628:therapy; D012306:Risk; D013514:Surgical Procedures, Operative / Q000009:adverse effects*