Kidney function
A number
Estimated glomerular filtration rate, on every routine panel.
Measurement
Perioperative physiology has no agreed way to be measured.
Surgery is one of the largest physiologic events a person will experience, and the field has no shared way to describe what state a patient is in before it, what the operation did to them, or whether they are recovering normally. PERIOME is building that measurement work. The Perioperative Resilience Index™ is one proposed framework within it.
The precedent
Virginia Apgar gave newborns a score in 1953.
It changed neonatal care because it made a fuzzy question answerable in sixty seconds. Before the score, whether a newborn was in trouble was a matter of individual judgment. After it, it was a number any two clinicians could compare, act on and follow over time.
That is what a measure does to a field. It turns an impression into something that can be tracked, taught, argued about and improved. Perioperative Health needs that, and it needs it for more than one moment in the window.
The gap
Almost every other question in the preoperative workup has a number attached to it.
One does not.
Cardiac risk
A number
Validated indices, calculated before most major operations.
Airway difficulty
A scale
Mallampati, assessed at the pre-anesthesia evaluation.
Readiness for what is about to happen
Not yet
No standard measure yet describes whether the body is prepared for the operation ahead.
Risk calculators predict what will happen to a patient. Perioperative measurement is concerned with what can still be changed before it does, and with what actually changed afterward.
What the window asks
Five things worth measuring across one operation.
A single score is not the whole problem. The surgical window raises several distinct measurement questions, and each one has to be answered against the individual patient rather than a population average.
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Perioperative baseline
What physiologic state this person is in before anything is done to them, established from their own data rather than assumed from their age and diagnosis.
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Readiness
What of that state can still be improved in the time remaining, and by how much. This is the question the protocol acts on.
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Surgical stress response
What the operation actually did to the patient, measured as a change from their own baseline rather than as a complication count.
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Recovery
Whether the patient is returning toward the state they started in, and how far they still are from it.
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Recovery trajectory
Whether that return is following the path it should for this person, early enough for the care team to act when it is not.
These are open questions, not settled instruments. Nothing described here is validated, and none of it is a diagnostic or a clinical device.
What goes in
Four kinds of possible signal.
Measuring any of this could draw on the same kinds of input: what the body is doing now, how the person actually lives, what the blood shows under stress, and, where it is clinically justified, what they inherited.
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Continuous physiologic signal
The patient's own physiology, recorded over time. Sleep, recovery, cardiovascular variability. Many patients already wear devices that capture some of it.
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Patient-reported baseline
What the chart cannot see. How a person actually eats, sleeps, moves and recovers, almost none of which survives into a medical record.
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Targeted laboratory values
Not the routine pre-op draw. A narrow set of markers chosen because they move under surgical stress, and can still be moved before it.
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Inherited biology
An optional input that never changes. Where evidence justifies it, drawn once, it could inform future operations.
These are potential inputs, not live integrations. Device data, targeted labs and genetics would each be optional and used only with the patient's permission. None is required, and none is in use today.
One proposed framework
The Perioperative Resilience Index™.
The PRI framework is PERIOME's proposal for the readiness question specifically: many signals resolved into six physiologic domains, and six domains resolved into a single measure a care team could act on before induction.
A single number is useful when a field agrees on what it means. That agreement does not exist yet, and the PRI framework is offered as a contribution to the question rather than as its answer. It is in development, any values shown anywhere on this site are illustrative, and it is not a diagnostic or a clinical device.
How it fits the systemThe wider question
A larger question than any one framework.
PERIOME is developing the Perioperative Resilience Index as a proposed way to express readiness as a single measure. What readiness should mean across the surgical window, and how a field should agree to measure it, is a larger question than any one framework.
That question is among the areas the Perioperative Health Council convenes around. The Council has not reviewed, validated or endorsed the PRI framework, and it is not a Council standard.
About the CouncilThe standard
A field becomes measurable before it becomes standard.
Understand the state a patient brings to surgery, improve what can still be changed, and follow what recovery actually does. The measurement has to come first.
Partner with PERIOMEIn development. Illustrative only, and not a diagnostic or clinical device.