Hypothesis| Volume 166, ISSUE 2, P147-149, August 2019

Preoperative epigenetic preparation of patients is a current reality

      With disappointing frequency, all surgeons are too often presented with the corpulent, 55-year-old, cigar-chomping banker whose idea of exercise is to walk down a single flight of stairs rather than taking the elevator, and even the 21-year-old single mother of three with no high school diploma who must lock and bolt her door and is constantly short of food stamps. These psychosocial–physiologic demographics of biologic stressors provoke increasingly predictable epigenetic alterations that confer enhanced surgical risk. The purposes of this report are as follows: (1) provide a primer on epigenetics; (2) relate socioeconomic status (SES) to changes in the epigenome; (3) suggest that SES-induced epigenetic alterations can be identified and targeted; and (4) introduce surgeons to the molecular tools for altering the epigenome, which governs the expression of the genome, as an accessible strategy of decreasing surgical risk.
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