Objective:

To evaluate the impact of personalized versus standard prehabilitation on preoperative immune signaling and clinical outcomes in patients undergoing major elective surgery, with a focus on comparative effectiveness.

Key Findings:

• Personalized prehabilitation led to significant improvements in physical (e.g., 6-minute walk test distance increased from 496 to 546 meters) and cognitive function (e.g., Quick Mild Cognitive Impairment scores increased from 66 to 72) compared to standard prehabilitation.
• Patients in the personalized group experienced fewer moderate to severe postoperative complications (4 vs 11).
• Immune profiles showed significant modulation in the personalized group, indicating a potential biological readiness for surgery.

Interpretation:

The delivery method of prehabilitation significantly influences both immune signaling and clinical outcomes, suggesting personalized approaches may enhance surgical readiness and improve immune response.

Limitations:

• All patients received some form of prehabilitation, limiting comparison with a control group with no intervention.
• The study was conducted at a single center with a small sample size.
• Heterogeneity in surgical procedures may have affected outcomes despite randomization.
• The targeted mass cytometry approach may have limited the detection of broader biological changes.

Conclusion:

Personalized prehabilitation shows promise in improving preoperative readiness and reducing complications, warranting further multicenter trials to validate these findings and explore immune biomarkers for high-risk patients.