{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:24:12Z","timestamp":1787293452981,"version":"build-2736575974"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Allostatic load (AL) is a measure of physiologic adaptation to repetitive environmental stressors and is associated with poor health outcomes and chronic conditions, ranging from cardiovascular disease and type 2 diabetes to malignancy. Given the acute rise in physiologic stress that accompanies surgically induced trauma, AL has the potential to affect surgical outcomes, particularly for the invasive, complex, lengthy procedures common in surgical oncology. The aims of this study were to systemically review existing literature surrounding AL and surgery, and to contextualize these findings accordingly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted in May 2024 via PubMed, Embase, Cochrane, Web of Science, and PsycINFO to identify existing literature on AL and surgery. Study quality and sources of bias were assessed via the Mixed Methods Appraisal Tool. Data from original studies were extracted and compiled, and a similar process was repeated for related review articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 10 original research studies explored the relationship between AL and surgical topics. Eight of these studies attempted to quantify AL as either a numerical composite index or via single or multiple representative biomarkers. AL emerged as (1) a specific predictor of surgical outcomes and (2) an explanatory mechanism for racial and socioeconomic disparities in surgical populations, as AL is known to be increased in socially disadvantaged individuals. Four of 10 included studies explored surgical oncology populations exclusively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>AL appears to impact surgical care and demonstrates the potential to not only predict postoperative outcomes (i.e., postoperative complications) but also identify high-risk surgical patients. This relationship appears to be most well-defined in surgical oncology relative to any other surgical specialty. By illuminating the connections between AL and surgery, targeted interventions aimed at reducing AL may be implemented to mitigate postoperative complications and improve the quality of surgical care. Future work in this area should include prospective studies examining preoperative AL, specific postoperative outcomes, and the impact of personalized AL-centered interventions on adverse perioperative outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1866869","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:37:00Z","timestamp":1787290620000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effects of allostatic load on patients undergoing surgery: a systematic review"],"prefix":"10.3389","volume":"13","author":[{"given":"Whitaker","family":"Reid","sequence":"first","affiliation":[{"name":"Department of Medical Education, Burnett School of Medicine at TCU","place":["Fort Worth, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidhi Rhea","family":"Udyavar","sequence":"additional","affiliation":[{"name":"Department of Surgery , University of Washington","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1089\/met.2021.0008","article-title":"Allostatic load, single, and dual chronic conditions: evidence from the national health and nutrition examination survey","volume":"20","author":"Memiah","year":"2022","journal-title":"Metab Syndr Relat Disord"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/2568635","article-title":"The impact of external factors on the epigenome: in Utero and over lifetime","volume":"2016","author":"Tora\u00f1o","year":"2016","journal-title":"BioMed Res Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1159\/000510696","article-title":"Allostatic load and its impact on health: a systematic review","volume":"90","author":"Guidi","year":"2021","journal-title":"Psychother Psychosom"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3017","DOI":"10.3390\/jcm13103017","article-title":"The surgical stress response and anesthesia: a narrative review","volume":"13","author":"Ivascu","year":"2024","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"4096","DOI":"10.3390\/jcm9124096","article-title":"Surgical stress promotes tumor progression: a focus on the impact of the immune response","volume":"9","author":"Onuma","year":"2020","journal-title":"J Clin Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s10585-018-9873-2","article-title":"Surgical stress response and promotion of metastasis in colorectal cancer: a complex and heterogeneous process","volume":"35","author":"Behrenbruch","year":"2018","journal-title":"Clin Exp Metastasis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.ygyno.2024.05.031","article-title":"Association of allostatic load with overall survival in epithelial ovarian cancer","volume":"186","author":"Borho","year":"2024","journal-title":"Gynecol Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"606","DOI":"10.3390\/cancers18040606","article-title":"Allostatic load predicts immune-related toxicity and survival in melanoma patients receiving immune checkpoint inhibitors","volume":"18","author":"Shen","year":"2026","journal-title":"Cancers (Basel)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1177\/1099800420969898","article-title":"Allostatic load in cancer: a systematic review and Mini meta-analysis","volume":"23","author":"Mathew","year":"2021","journal-title":"Biol Res Nurs"},{"key":"B10","doi-asserted-by":"publisher","first-page":"4770","DOI":"10.1073\/pnas.081072698","article-title":"Allostatic load as a marker of cumulative biological risk: macArthur studies of successful aging","volume":"98","author":"Seeman","year":"2001","journal-title":"Proc Natl Acad Sci"},{"key":"B11","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1089\/jwh.2010.2170","article-title":"Racial and ethnic patterns of allostatic load among adult women in the United States: findings from the national health and nutrition examination survey 1999\u20132004","volume":"20","author":"Chyu","year":"2011","journal-title":"J Womens Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1177\/1099800412455688","article-title":"A systematic review of allostatic load, health, and health disparities","volume":"14","author":"Beckie","year":"2012","journal-title":"Biol Res Nurs"},{"key":"B13","doi-asserted-by":"publisher","first-page":"100771","DOI":"10.1016\/j.ssmph.2021.100771","article-title":"Social status differences in allostatic load among young adults in the United States","volume":"15","author":"Richardson","year":"2021","journal-title":"SSM Popul Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"110434","DOI":"10.1016\/j.jpsychores.2021.110434","article-title":"The impact of discrimination on allostatic load in adults: an integrative review of literature","volume":"146","author":"Miller","year":"2021","journal-title":"J Psychosom Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1777","DOI":"10.1016\/j.surg.2021.06.001","article-title":"Profiles in social vulnerability: the association of social determinants of health with postoperative surgical outcomes","volume":"170","author":"Paro","year":"2021","journal-title":"Surgery"},{"key":"B16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.amjsurg.2023.09.028","article-title":"Social vulnerability is associated with higher risk-adjusted rates of postoperative complications in a broad surgical population","volume":"229","author":"Dyas","year":"2024","journal-title":"Am J Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1038\/s41523-021-00309-6","article-title":"Allostatic load: a framework to understand breast cancer outcomes in black women","volume":"7","author":"Obeng-Gyasi","year":"2021","journal-title":"Npj Breast Cancer"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e023","DOI":"10.1097\/AS9.0000000000000023","article-title":"Racial disparities in surgery: a cross-specialty matched comparison between black and white patients","volume":"1","author":"Azin","year":"2020","journal-title":"Ann Surg Open"},{"key":"B19","doi-asserted-by":"publisher","first-page":"201","DOI":"10.2471\/BLT.15.159293","article-title":"Size and distribution of the global volume of surgery in 2012","volume":"94","author":"Weiser","year":"2016","journal-title":"Bull World Health Organ"},{"key":"B20","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/S1470-2045(20)30675-6","article-title":"Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study","volume":"22","author":"Perera","year":"2021","journal-title":"Lancet Oncol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"B22","author":"Hong","year":""},{"key":"B23","doi-asserted-by":"publisher","first-page":"e172","DOI":"10.1097\/MAT.0000000000000847","article-title":"Physiological and psychological stress in patients living with a left ventricular assist device","volume":"64","author":"Abshire","year":"2018","journal-title":"ASAIO J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1016\/j.jnma.2019.04.009","article-title":"Trends in in-hospital coronary artery bypass surgery mortality by gender and race\/ethnicity \u20131998\u20132015: why do the differences remain?","volume":"111","author":"Becker","year":"2019","journal-title":"J Natl Med Assoc"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1788","DOI":"10.1200\/JCO.23.00907","article-title":"Association between neighborhood opportunity, allostatic load, and all-cause mortality in patients with breast cancer","volume":"42","author":"Chen","year":"2024","journal-title":"J Clin Oncol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1245\/s10434-023-14431-1","article-title":"The implications of racialized economic segregation and allostatic load on mortality in patients with breast cancer","volume":"31","author":"Chen","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41523-024-00654-2","article-title":"Allostatic load as a predictor of postoperative complications in patients with breast cancer","volume":"10","author":"Chen","year":"2024","journal-title":"Npj Breast Cancer"},{"key":"B28","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1007\/s12311-021-01251-w","article-title":"Impact of surgical Status, loneliness, and disability on interleukin 6, C-reactive protein, cortisol, and estrogen in females with symptomatic type I chiari malformation","volume":"20","author":"Garcia","year":"2021","journal-title":"The Cerebellum"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e937957","DOI":"10.12659\/MSM.937957","article-title":"Thyroid-Stimulating hormone as a biomarker for stress after thyroid surgery: a prospective cohort study","volume":"28","author":"Hong","year":"2022","journal-title":"Med Sci Monit"},{"key":"B30","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.jvs.2021.08.071","article-title":"The influence of socioeconomic status on outcomes of lower extremity arterial reconstruction","volume":"75","author":"Hughes","year":"2022","journal-title":"J Vasc Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2144","DOI":"10.3390\/jcm11082144","article-title":"Allostatic load as an insight into the psychological burden after primary treatment in women with breast cancer: influence of physical Side effects and pain perception","volume":"11","author":"Irelli","year":"2022","journal-title":"J Clin Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e12825","DOI":"10.1111\/acel.12825","article-title":"A molecular signature for delayed graft function","volume":"17","author":"McGuinness","year":"2018","journal-title":"Aging Cell"},{"key":"B33","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1007\/s11916-008-0018-1","article-title":"What are the psychiatric sequelae of burn pain?","volume":"12","author":"Askay","year":"2008","journal-title":"Curr Pain Headache Rep"},{"key":"B34","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1093\/bja\/aex064","article-title":"Reply: allostatic load as an approach to support the theoretical assumptions of the Brief Measure of Emotional Preoperative Stress (B-MEPS)","volume":"118","author":"Caumo","year":"2017","journal-title":"Br J Anaesth"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1245\/s10434-023-14507-y","article-title":"ASO author reflections: racialized economic segregation and allostatic load: the impact of internalizing our residential environments","volume":"31","author":"Chen","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/j.surg.2014.09.032","article-title":"Socioeconomic status and the assessment of operative risk","volume":"157","author":"Chong","year":"2015","journal-title":"Surgery"},{"key":"B37","first-page":"149","article-title":"The allostatic load caused by surgery","volume":"20","author":"Christodoulou","year":"2017","journal-title":"Hell J Nucl Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.jnma.2018.02.003","article-title":"Racial\/ethnic disparities in lower extremity amputation vs revascularization: a brief review","volume":"110","author":"Hughes","year":"2018","journal-title":"J Natl Med Assoc"},{"key":"B39","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.fertnstert.2023.01.022","article-title":"Racial disparities in uterine fibroids and endometriosis: a systematic review and application of social, structural, and political context","volume":"119","author":"Katon","year":"2023","journal-title":"Fertil Steril"},{"key":"B40","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1089\/sur.2012.124","article-title":"Update and review of racial disparities in sepsis","volume":"13","author":"Vogel","year":"2012","journal-title":"Surg Infect"},{"key":"B41","first-page":"20","article-title":"The impact of psychological stress on wound healing: a theoretical and clinical perspective","volume":"15","author":"Wynn","year":"2019","journal-title":"Wounds UK"},{"key":"B42","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1001\/archinte.1993.00410180039004","article-title":"Stress and the individual: mechanisms leading to disease","volume":"153","author":"McEwen","year":"1993","journal-title":"Arch Intern Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.annepidem.2019.02.011","article-title":"The weathering hypothesis as an explanation for racial disparities in health: a systematic review","volume":"33","author":"Forde","year":"2019","journal-title":"Ann Epidemiol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1080\/10253890.2020.1784136","article-title":"A scoping review of interventions targeting allostatic load","volume":"23","author":"Rosemberg","year":"2020","journal-title":"Stress"},{"key":"B45","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.amepre.2024.04.009","article-title":"Association of occupational and leisure-time physical activity with allostatic load","volume":"67","author":"Xia","year":"2024","journal-title":"Am J Prev Med"},{"key":"B46","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1016\/j.whi.2015.07.002","article-title":"Greater leisure time physical activity is associated with lower allostatic load in white, black, and Mexican American midlife women: findings from the national health and nutrition examination survey, 1999 through 2004","volume":"25","author":"Upchurch","year":"2015","journal-title":"Womens Health Issues"},{"key":"B47","doi-asserted-by":"publisher","first-page":"227","DOI":"10.6133\/apjcn.202306_32(2).0005","article-title":"Adults allostatic load is less with greater dietary quality: national health and nutrition examination survey (NHANES) 2015\u20132018","volume":"32","author":"Zhang","year":"2023","journal-title":"Asia Pac J Clin Nutr"},{"key":"B48","doi-asserted-by":"publisher","first-page":"6747","DOI":"10.3390\/jcm14196747","article-title":"Prehabilitation: a catalyst for transforming toward value-based, personalized perioperative health and care","volume":"14","author":"Van Koningsveld-Couperus","year":"2025","journal-title":"J Clin Med"},{"key":"B49","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/978-3-030-82052-7_11","article-title":"Psychosocial and patient support services in comprehensive cancer centers","volume-title":"The Comprehensive Cancer Center","author":"Chakraborty","year":"2022"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2259","DOI":"10.1001\/archinte.1997.00440400111013","article-title":"Price of adaptation\u2013allostatic load and its health consequences. MacArthur studies of successful aging","volume":"157","author":"Seeman","year":"1997","journal-title":"Arch Intern Med"},{"key":"B51","doi-asserted-by":"publisher","first-page":"7723","DOI":"10.1245\/s10434-025-17711-0","article-title":"The hidden burden: impact of allostatic load on colorectal cancer surgery outcomes","volume":"32","author":"Khalil","year":"2025","journal-title":"Ann Surg Oncol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1245\/s10434-025-18144-5","article-title":"Impact of social vulnerability and allostatic load on postoperative outcomes","volume":"33","author":"Khalil","year":"2026","journal-title":"Ann Surg Oncol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1866869\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:37:01Z","timestamp":1787290621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1866869\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":52,"alternative-id":["10.3389\/fsurg.2026.1866869"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1866869","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"1866869"}}