The allostatic load caused by surgery

The allostatic load is described as a combination of somatic and neuropsychiatric damage which is carried along one's health status as a permanent and irreversible result but is also closely related to socioeconomic factors. The allostatic load caused by surgery has very much to do with surgical stress which varies according to the kind of operation and existing comorbidities. Anesthesia, analgesia, long stay in Intensive Care Units, and post surgical interventions consist what the surgeon himself may cause as an independent prognostic factor. Any surgical operation may cause a sequence of physiological responses which in major surgery may take place out of the homeostatic range. When it does, an allostatic process determines the ultimate route to survival. When a major operation takes place, with long duration and severe violation of the involved organs physiology, then brain, liver and adrenals react with scientifically documented patterns described by the theories of the organ axes. According to its first literature appearance, allostasis has been described mostly as a cumulative damage and not as a sudden shock, so it is accepted that surgical operations might play a crucial role in allostatic chronic conditions or major postoperative disabilities. Surgical diseases that could represent allostatic phenomena are Inflammatory Bowel Diseases (IBD), morbid obesity before and after a bariatric operation, post-injury conditions (multi-trauma cases), patients before and after transplantation, and patients with stomas or long-standing artificial enteral nutrition. Old age and concomitant diseases are significant factors for developing fast allostatic changes which can be documented with stress -related biochemical testing. Common preoperative tests are planned under the limitations on low-cost health services. Thus, patients that undergo major operations are in greater risk of allostatic changes, due to the combination of aging, concomitant diseases and hidden predisposing factors (unrevealed with common tests). In dementia, preoperative preparation is a very sensitive and less studied issue, even for patients who have already been diagnosed for dementia and have received personalized therapies and been followed up for years. The special role of the pre-anesthetic examinations could be more extensive in Bariatric Surgery and in Inflammatory Bowel Diseases.