The microbiome is an exciting frontier in patient wellness and disease management. At this year’s FACS clinical congress meeting in Sandiego, the field is moving to examine complex interactions of different bacterial types. Today, to be a good surgeon doesn’t mean just having good technical results – it also means expediting postoperative recovery. Infection is one the most common reasons that a patient stays in the hospital longer or is readmitted following a surgical procedure. Dynamic changes in the microbiome are known to cause postoperative issues, which can also be characterized as a postoperative inflammatory disorder initiated and driven by an altered microbiome. Unfortunately, it remains a challenge to understand the bacterial organisms that cause surgical complications, since more than 50 percent of the organisms in the human gut are impossible to culture. Surgeons have found that using broad spectrum antibiotics can actually worsen immune function by interrupting immune homeostasis. “What we know now from all the microbiome studies, is that you need your microbiome to stimulate your immune system and keep it robust.” Scientists and physicians are still trying to learn why serious infections happen to some patients after surgery. In short, “we need to understand at the most basic level why things happen to some patients and not others.” The answer will come, in part, from a better understanding of the microbiome.