Epigenetics, inflammation and postoperative complications: a scoping review

Area of Science:

• Perioperative Medicine
• Epigenetics
• Inflammation Research

Background:

• Excessive postoperative inflammation leads to complications, mortality, and increased healthcare costs.
• Epigenetic modifications influence gene transcription and can amplify inflammatory responses.
• Translational research is exploring the role of epigenetics in perioperative inflammation.

Purpose of the Study:

• To conduct a scoping review of studies investigating epigenetic mechanisms in perioperative inflammation and complications.
• To consolidate findings in this emerging field.
• To provide recommendations for future research directions.

Main Methods:

• Protocol registered and published following best-practice guidelines.
• Searches conducted in Medline and Embase for English-language studies (1946-2025).
• Independent screening of titles, abstracts, and full texts by two reviewers, followed by data extraction.

Main Results:

• 26 articles were included from 15,451 assessed studies, published between 2016-2025.
• Cardiac surgery was most frequently studied; microRNA mechanisms were common, while DNA methylation and histone modifications were less explored.
• Complications and inflammation were variably defined and assessed, with C-reactive protein and interleukin-6 being common markers.

Conclusions:

• DNA methylation and histone modifications require further investigation in perioperative inflammation.
• Future studies should standardize surgical insults, inflammation measures, and complication definitions for enhanced generalizability.
• Experimental approaches like transcriptomics and proteomics can advance mechanistic understanding.