Immune Modulation by Personalized vs. Standard Prehabilitation Before Major Surgery: A Randomized Controlled Trial

Area of Science:

• Immunology
• Surgery
• Personalized Medicine

Background:

• Prehabilitation (prehab) programs aim to improve surgical outcomes but lack personalized, pathophysiologically-driven implementation.
• The efficacy of standard prehab is debated due to limited individual tailoring.

Purpose of the Study:

• To assess the impact of personalized versus standard prehabilitation on preoperative physical, cognitive, and immune function.
• To evaluate the effect of prehab on postoperative outcomes in patients undergoing major elective surgery.

Main Methods:

• A prospective, single-blinded, randomized trial involving 58 patients undergoing major elective surgery.
• Patients were randomized to either standard (paper-based) or personalized (remote coaching) prehab programs.
• Immune function was assessed using mass cytometry, alongside physical and cognitive performance measures.

Main Results:

• The personalized prehab group showed significant improvements in physical function (6MWT; p=0.03) and fewer severe postoperative complications (4 vs. 11; p=0.04).
• Personalized prehab induced profound, cell-type specific immune alterations, dampening pro-inflammatory signaling (AUROC=0.88).
• The standard prehab group had moderate clinical improvements but no significant immune changes (AUROC=0.63).

Conclusions:

• Personalized prehabilitation effectively modulates the immune system, dampening inflammatory responses linked to surgical complications.
• These immune changes correlate with improved physical and cognitive function and reduced postoperative complications.
• Findings support personalized prehab for optimizing surgical readiness and suggest a pathway for biologically-driven patient stratification.