UCLA Health has created a new institute for precision medicine, a key piece of a larger precision health venture within the UCLA Clinical and Translational Science Institute (CTSI). Our department has become a vital partner in the implementation of this program, particularly in the realm of cardiovascular precision medicine.
Each patient who presents to our preoperative assessment clinic or is admitted for same-day surgery is asked to donate a blood sample to be used for genomic analysis. The sheer size and diversity of the UCLA health system provides the resources necessary to collect and preserve the samples, store large data files, and link high-powered genetic analysis of the samples with outcomes data from our electronic health record system. Our researchers are developing computational tools for the analysis of genetic data to facilitate the study of complex conditions such as cancer, rheumatoid arthritis, and cardiovascular disease.
As perioperative physicians, we face new challenges to patient care in an era of constrained resources, more procedures needed by patients with complex and critical illnesses, and an aging population. Genomics has the potential to provide us with the tools necessary to anticipate how each individual patient will respond to the numerous stresses and pharmacological exposures of the perioperative period. We will be able to study the responses of patients with different genetic subtypes to commonly used pain medications, anesthetics, antihypertensive medications, and anticoagulants. If we can understand the contribution of the genetic makeup to the outcomes of our patients, we will truly be able to personalize their care, choosing the best medication every time.
Researchers in precision medicine expect to find that patients will fit into different genomic categories. The goal is to use the preoperative blood samples, together with tissue samples collected at the time of surgery, to identify groups of patients at higher risk for complications such as stroke, myocardial infarction, acute kidney injury, bleeding, arrhythmias, cognitive decline, and sepsis. Once the genetic variants are identified, the data can be used to develop better care strategies, including the appropriate preoperative medical management, degree of surgical invasiveness, plan for intraoperative anesthesia, and level of post-operative care.
Anesthesiologists face a major challenge in assimilating genomic information into the current model of perioperative health care. There is tension between the concepts of standardized protocols for efficient, high-quality healthcare and individualized care via precision medicine. Our faculty members have discussed this concept in a lead article in Anesthesia & Analgesia, titled “Standardized Care Versus Precision Medicine in the Perioperative Setting.”
Our department believes there is great promise in overcoming these challenges and providing even better care to our patients. We are proud to play a pivotal role in developing precision healthcare at UCLA as we acknowledge the tremendous impact of genomics and precision medicine on the future of medicine.