American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Microbiome insights can reduce postoperative complications

OCTOBER 23, 2017
Clinical Congress Daily Highlights, Monday Second Edition

The microbiome is a new frontier in patient wellness and disease management. At this year’s I. S. Ravdin Lecture in the Basic and Surgical Sciences, John C. Alverdy, MD, FACS, reported that the field is moving away from monomicrobial diseases to examine complex interactions of different bacterial types. Dr. Alverdy, associate co-director of the University of Chicago Digestive Disease Research Core Center, IL, traced that evolution.

Today, he said, being a good surgeon doesn’t mean just having good technical results – it also means expediting postoperative recovery. Ileus and infection are the most common reasons that a patient stays in the hospital longer or is readmitted following a surgical procedure. Dynamic changes in the microbiome are known to cause postoperative ileus, which can also be characterized as a postoperative inflammatory disorder initiated and driven by an altered microbiome.

Unfortunately, it remains a challenge to understand the bacterial organisms that cause surgical complications, since more than 50 percent of the organisms in the human gut are impossible to culture. Surgeons have found that using broad spectrum antibiotics can actually worsen immune function by interrupting immune homeostasis. “What we know now from all the microbiome studies,” Dr. Alverdy said, “is that you need your microbiome to stimulate your immune system and keep it robust.”

Other microbiome medicine approaches that still require better understanding include fecal transplants, bowel prep methods, and enhanced recovery programs.

Scientists and physicians are still trying to learn why serious infections happen after surgery. In short, “we need to understand at the most basic level why things happen to some patients and not others.” Dr. Alverdy is convinced the answer will come from a better understanding of the microbiome.

Additional Information:
The Named Lecture, I. S. Ravdin Lecture in the Basic and Surgical Sciences, was held October 23, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

Return to Index