Tue, Sep 30, 2014 - Page 12 News List

About bloody time

Researchers say that a patients’ blood harbors clues about how fast they will bounce back from surgery

By Lauran Neergaard  /  AP, WASHINGTON

Surgeons of the Canadian NGO “Mission sourire d`Afrique” (Africa smile mission) surgically repair the harelip on a young boy in February. The average recovery time following surgery is three weeks, but some patients recuperate in as little as one week, while others require up to six. Researchers think the disparity lies in immune cells.

Photo: AFP

One of the big frustrations of surgery: There’s little way to know if a patient will be a fast or slow healer, someone who feels back to normal in a week or is out of work for a month with lingering pain and fatigue.

Now Stanford University researchers have discovered that right after surgery, patients’ blood harbors clues about how fast they will bounce back — and it has to do with the activity of certain immune cells that play a key role in healing.

The work one day may lead to a test to predict who’ll need more care, or maybe even if an operation is the best choice.

“We could ask, ‘Are you fit for surgery?”’ said Martin Angst, a Stanford professor of anesthesiology and perioperative medicine, who helped lead the research published last week.

RECOVERY TIME

US doctors perform millions of operations every year, many of them minor, but others much more complex. Speed of recovery depends in part on the type of surgery and how sick the person is. Some hospitals have begun implementing “enhanced recovery” strategies, specific steps to take right before and after certain major operations in hopes of at least speeding the patient’s discharge from the hospital, if not their overall recuperation time.

But scientists don’t know what biology explains why some people recover so much faster than someone else who’s equally sick, information that could help guide development of those enhanced-recovery programs.

“I’m very excited that the science around surgery recovery is going that direction,” said Julie Thacker, a colorectal surgeon at Duke University who wasn’t involved in the new study but praised the work.

Thacker has helped implement an enhanced-recovery program at Duke that she said works well, but said she can’t explain which steps are most important or why without research into how they affect such things as the body’s inflammatory response.

The Stanford team took an unusually close look at 32 otherwise fairly healthy people who underwent a first-time hip replacement. They took blood samples from the patients before surgery and at several points afterward, and questioned them pain, fatigue and other elements of recovery every few days for six weeks.

That recovery was quite varied: Some experienced only mild pain just two days after surgery, while others didn’t report their pain was mostly gone until 36 days later. The median time to recuperate from post-surgical fatigue, extreme tiredness after simple activity, was three weeks, meaning half of patients fared better and half took longer.

MAPPING IMMUNE CELL ACTIVITY

To learn why, the researchers looked to immune cells that are behind the inflammation that always occurs with a wound. To find and map the activity of key players, they turned to the lab of Stanford immunology professor Garry Nolan, who helped develop a technology that measures dozens of features of individual immune cells simultaneously.

The discovery: Patients’ blood shows an immune signature of recovery that accounts for much of their variability in recovery time — a pattern of activity in certain immune cells that are first responders to the injury site, the researchers reported Wednesday last week in Science Translational Medicine.

If that particular reaction is controlled in the first 24 hours after surgery, patients recover faster. But when that reaction increases instead, patients recover more slowly, Angst said.

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