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

Amélie Cambriel^1,2,3, Amy Tsai^1,4, Benjamin Choisy^1,5

¹Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.

|November 12, 2025

Summary

Personalized prehabilitation significantly improved physical function and reduced postoperative complications by altering the immune system. Standard prehabilitation showed only moderate clinical benefits without immune changes, highlighting the value of tailored interventions.

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Area of Science:

Surgical Outcomes Research
Immunology
Personalized Medicine

Background:

Prehabilitation programs aim to enhance surgical outcomes but lack personalized, pathophysiologically driven implementation.
The efficacy of standard prehabilitation is debated due to limited individual tailoring.

Purpose of the Study:

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

Main Methods:

A prospective, single-blinded, randomized trial involved 58 patients assigned to standard (paper-based) or personalized (remote coaching) prehabilitation.
Interventions covered physical activity, nutrition, cognitive training, and mindfulness.
Outcomes included physical performance tests (e.g., 6-minute walk test) and immune cell profiling via mass cytometry.

Main Results:

The personalized group showed significant improvements in physical measures (e.g., 6-minute walk test) and fewer postoperative complications (4 vs. 11).
Personalized prehabilitation induced significant, cell-type specific alterations in immune signaling pathways.
The standard group had moderate clinical improvements but no significant immune changes.

Conclusions:

Personalized prehabilitation effectively modulated the pre-surgical immunome, dampening inflammatory responses linked to adverse surgical outcomes.
These immunological changes correlated with enhanced physical and cognitive function and reduced postoperative complications.
Personalized prehabilitation offers a biologically driven approach to optimize surgical readiness and recovery.