Personalised care and subgroup evidence: anticipated effects, exploratory models, and evidentiary standards

Personalised treatment strategies are increasingly promoted in perioperative and critical care medicine, yet the evidentiary basis for their routine clinical adoption remains heterogeneous. Some approaches reflect anticipated, biologically coherent subgroup effects along established risk gradients, while others propose individualised treatment selection based on exploratory, data-driven models derived from high-dimensional analyses. We argue that personalisation is not a binary concept but exists along a continuum of evidentiary credibility, and should be evaluated according to subgroup plausibility, reproducibility, and transportability rather than novelty alone. A proportionate, evidence-first framework is proposed to clarify when stratified care is robust and when exploratory personalisation requires substantially higher evidentiary support.