In surgical patients, the development of post operative sepsis and the high rate of mortality may be related to defects in host immune mechanisms. The presence of anergy defines patients with a high rate of sepsis and mortality. Factors know to depress cell mediated immunity are essentially malignancy and sepsis. Those two factors are often associated with protein calorie malnutrition. The presence of anergy require further explorations in order to discover disseminated malignancy and/or latent sepsis. Those two factors are the major determinant of post operative risks.