DxSurgical empowers clinicians to tailor and optimize surgical and anesthetic planning based on a patient’s unique genetic profile.
Understanding a patient’s genetic risks with DxSurgical* testing services can help providers make more effective medication and management decisions throughout the perioperative experience.
Patients often experience a wide range of responses to anesthesia and analgesia in the perioperative setting due to numerous factors including type of surgery, weight, age, pain sensitivity, tolerance to opioids, and genetics. As many as 40% of surgical patients experience respiratory depression and/or uncontrolled pain post-operatively, each instance adding nearly $5,000 to the cost of care as measured by hospital charges for affected patients.1,2
DxSurgical* is a non-invasive genetic test that can help health care providers optimize medication therapy for perioperative care and also identify patients at increased risk for thromboembolic complications following surgery.
Many perioperative complications are associated with genetic susceptibilities that may be unknown in advance of surgery. These complications may lead to:
Data suggests that, on average, 20-40% of patients are expected to experience post-operative nausea and vomiting.3
Studies have shown that post-surgery vomiting is ranked as the least desirable anesthesia outcome 4; while inadequate pain control and venous thromboembolism have been shown to be among the top 10 reasons for unplanned readmissions post-surgery.5
Personalized care tailored to a patient’s genetic profile with DxSurgical:
Provides objective information to help providers make rational, patient-tailored decisions throughout the surgical process
Identifies potential risk of surgical complications such as venous thromboembolism (VTE)
Helps guide medication selection and dosing of agents used in anesthetic and analgesic planning to maximize efficacy and minimize toxicity
| Medication Class | Medication | Genes | Potential Clinical Impact |
|---|---|---|---|
| Analgesics | Codeine, Fentanyl, Hydrocodone, Morphine, Oxycodone, Tramadol | CYP2D6, CYP3A4, CYP3A5, COMT, OPRM1 | May be used to optimize analgesic selection or dosage to help reduce risk of opioid toxicity and achieve analgesia.6-9 |
| Antiemetics | Ondansetron | CYP2D6 | Ultrarapid metabolizers of CYP2D6 may experience therapeutic failure with ondansetron for the prevention and treatment of nausea and vomiting.10 A different anti-emetic therapy may be more effective. |
| Neuromuscular blockers | Succinylcholine | BCHE | BCHE deficient patients receiving succinylcholine may be at risk of prolonged neuromuscular blockade, potentially leading to respiratory depression.11 A different neuromuscular blocker may be more appropriate. |
| Sedatives | Midazolam | CYP3A4/5 | Genetic variations in CYP3A4/CYP3A5 may affect enzyme activity and plasma levels, potentially impacting efficacy and adverse events.6, 12-15 |
| Consideration | Genes or Markers | Potential Clinical Impact | |
| Warfarin sensitivity | CYP2C9, VKORC1 | Patients with increased sensitivity to warfarin may need a dose reduction to lower risk of bleeding. Limited evidence indicates that patients with reduced CYP2C9 function may not be able to achieve normalized INR with the standard 5 day interruption period prior to surgery.16-17 | |
| Venous Thromboembolism (VTE) | Factor V Leiden, Factor II (G20210A) | Patients with Factor V Leiden or Factor II (G20210A) have increased risk for VTE. These results should be considered as part of a comprehensive VTE risk assessment and mitigation strategy.18-21 | |
A summary of the potential clinical impact a patient’s genetic profile may have on their response to medications or their risk for complications in perioperative management
Knowledge of a patient’s genetic risk prior to scheduled surgery helps providers to optimize perioperative decision-making and tailor medication selection for each patient.
For an individual patient, a more complete description of the clinical significance is provided in the Perioperative Gene Analysis Report. This report provides medication specific genetic results in a user-friendly format with additional information about how a patient’s genetics may impact his or her response to common medications used in surgery and potential risks for certain surgery-related complications.
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The CogenDx logo is a service mark or registered service mark of Millennium Health, LLC or its subsidiaries in the United States and other Countries. All other trademarks used herein are the property of their respective owners. These clinical laboratory developed tests (LDTs) were developed and their performance characteristics determined by Millennium Health, LLC and have not been cleared or approved by the US Food and Drug Administration (FDA). These LDTs are clinical tests and their results should be used with other clinical observations and diagnostic findings for patient case management. Millennium Health, LLC maintains certification in accordance with Clinical Laboratory Improvement Amendments of 1988 and is accredited by the College of American Pathologists.