Research

An operation is a physiologic event. The evidence for preparing for it is decades deep.

PERIOME is working to advance Perioperative Health as a measurable discipline: defining what to measure across the surgical window, asking which preparation matters, and publishing its reasoning as the evidence develops.

Research collaboration See the system

The central question.

Surgery is one of the few major health events medicine can see coming. That makes the weeks around it an unusual opportunity to understand a patient, prepare them, and follow their recovery.

How much healthier can we help someone be before surgery, and how completely can we help them recover afterward?

Context

  • 50 million Operations performed each year in the United States.
  • 1 in 4 Patients aged 60 and over with measurable cognitive decline in the first week after major non-cardiac surgery.

Surgical volume: Lancet Commission on Global Surgery. Cognitive figures: ISPOCD and Monk et al., studied at the time as postoperative cognitive dysfunction.

Clearance and readiness

The preoperative workup answers whether a patient can proceed. Readiness asks a different question.

Labs, imaging, an ECG, fasting instructions and consent establish whether surgery is safe to undertake. ERAS pathways go further, and already address parts of the preoperative period, including carbohydrate loading.

Readiness asks what state the patient is in: hydration and metabolic reserve through fasting, the neurocognitive baseline at induction, gut integrity under antibiotic and anesthetic exposure, and the capacity available for repair. Those questions are rarely measured together, for one patient, across the whole window.

The clinical framework

Six domains, each with its own physiologic rationale.

The PERIOME Protocol is formulated across six physiologic domains relevant to the surgical window, each chosen for a perioperative-specific reason rather than general wellness.

  1. Hydration and electrolytes

    Fluid and electrolyte status entering the preoperative fasting period.

  2. Metabolic and recovery capacity

    The shift toward catabolism that fasting produces, immediately before repair is required.

  3. Neurocognitive resilience

    The neurocognitive baseline a patient carries into induction.

  4. Immune and inflammatory resilience

    The inflammatory and repair response to a controlled surgical injury.

  5. GI integrity and microbiome

    Gut barrier integrity under simultaneous antibiotic, fasting and anesthetic stress.

  6. Micronutrient foundation

    The substrate wound healing and recovery draw on.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

The measurement problem

Readiness is a state before it is a score.

Surgical risk is well documented before an operation. Readiness, meaning what a patient brings and what can still change, has no agreed measure yet.

The Perioperative Resilience Index™ is one proposed framework inside a broader measurement effort. It is in development, illustrative only, and not a diagnostic.

How measurement works

How to read our science

Six kinds of statement, kept apart.

A new discipline is easy to oversell. Everything PERIOME publishes about the science of Perioperative Health falls into one of these categories, and is labeled for what it is.

  • Established sciencePeer-reviewed findings, verified against the original papers and collected in the Evidence Library.
  • Emerging evidencePromising but early or mixed results, labeled as such where they appear.
  • PERIOME hypothesesThe questions PERIOME is working on, set out below as lines of inquiry, not findings.
  • Proposed frameworksThe loop, the six domains and the Perioperative Resilience Index™: organizing proposals, not validated instruments.
  • Pilot findingsReported only after a pilot has run its agreed measures and been reviewed.
  • Future prioritiesThe research agenda the Perioperative Health Council convenes around.
Open the Evidence Library

Lines of work

The questions we are working on.

Proving individual ingredients is necessary and not sufficient. The harder questions are about the patient as a whole, measured across the window rather than at a single visit.

  1. Perioperative baseline physiology

    What a meaningful preoperative baseline consists of, and how much of it can be drawn from data a patient already carries.

  2. Readiness and what is modifiable

    Which components of that baseline can still be changed in the days before an operation, by how much, and by what.

  3. Surgical stress response

    What the operation itself does to a patient, measured as a departure from their own baseline rather than as a complication count.

  4. Recovery trajectories

    What a normal return toward baseline looks like for a given patient, including functional recovery and what the patient reports, not only what the chart records.

  5. Intervention and response

    Which patients respond to which preparation, and whether response can be anticipated rather than observed after the fact.

  6. Measurement science

    How any of this should be measured at all: the instruments, the standards of evidence, and eventually models that predict rather than describe.

These are active lines of inquiry, not settled findings. PERIOME has published no clinical outcomes, and nothing here should be read as a claim of validated benefit.

Evidence Library

The science of Perioperative Health.

A curated library of the research behind the discipline, across six areas from physiologic readiness to implementation. Each entry sets out what investigators found and why it matters, with a link to the full study.

Published research and PERIOME's own proposed frameworks are kept clearly apart.

Open the Evidence Library

The research agenda

Building the research agenda together.

Perioperative Health will not become a discipline because one company declares it one. Through the Perioperative Health Council, PERIOME is bringing together clinicians, researchers and healthcare leaders to help identify the measurements, questions and evidence the field needs next.

From defining a core perioperative measurement set to studying modifiable readiness before surgery and recovery trajectories afterward, the agenda should be shaped by the people working across the surgical continuum. The Council convenes around those questions; it has not published findings or guidelines.

About the Council

In the open

A discipline is built in the open, with the people advancing it.

PERIOME publishes its clinical reasoning and welcomes research collaboration from the clinicians and investigators defining this window.

Research and clinical collaboration

Patent pending. Founded 2026. Origin thesis 2023.