Epigenetics, inflammation and postoperative complications: a scoping review

Area of Science:

• Perioperative Medicine
• Epigenetics
• Inflammation Research

Background:

• Excessive postoperative inflammation leads to significant morbidity, mortality, and healthcare costs.
• Epigenetic modifications, which alter gene transcription without changing DNA sequence, play a role in regulating inflammatory responses.
• Translational research is exploring the influence of epigenetic mechanisms on perioperative inflammation and complications.

Purpose of the Study:

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

Main Methods:

• A comprehensive literature search was performed in Medline and Embase for studies published between 1946 and 2025.
• Studies were screened by two independent reviewers based on titles, abstracts, and full texts.
• Included studies focused on postoperative complications, epigenetic mechanisms, and inflammation.

Main Results:

• 26 articles were included from an initial assessment of 15,451 studies, published between 2016 and 2025.
• Cardiac, general, and colorectal surgeries were most frequently studied; other specialties were underrepresented.
• MicroRNA mechanisms were most commonly investigated, while DNA methylation and histone modifications were less explored. Definitions of complications and assessments of inflammation were heterogeneous.

Conclusions:

• DNA methylation and histone modifications represent under-researched areas in perioperative inflammation.
• Future studies should standardize patient cohorts, inflammation measures (e.g., C-reactive protein, interleukin-6), and complication definitions for enhanced generalizability.
• Experimental approaches like transcriptomics and proteomics can advance mechanistic understanding.