When someone is training to run a marathon, to perform in a ballet, or to scale a mountain, they prepare through a strict regimen of exercise, sleep, and diet. Undergoing a major surgery is equally demanding on the body, according to the authors of a new study, yet many people neglect the preoperative guidance provided. The study published today in JAMA Surgery reports data on how better preparation for surgery—what the authors call “prehabilitation” or “prehab”—can hasten recovery by changing both attitudes and immune systems.
No one looks forward to the painful, drawn-out recovery process that tends to follow major surgeries. The rehab can be harder than the problem that necessitated the surgery. Notwithstanding the effectiveness of surgeries in treating many conditions, the operation itself deals a trauma to the body, sometimes severe.
Stanford Medicine researchers wondered whether a more hands-on approach to prehab guidance would make a post-op difference for patients recovering from surgery. They studied 54 pre-surgery patients, half of which received a pre-operative booklet, while the other half received personalized coaching. The participants in the treatment group were coached via video chat twice a week, with one session focused on exercise, and the other on nutrition, sleep, and mindfulness.
Read more: “Under Anesthesia, Where Do Our Minds Go?”
Of 27 patients who only got a preoperative booklet, 11 experienced significant postoperative complications. Of the 27 who got coaching, only four had complications. Those who received personalized prehab also demonstrated improvements in physical and cognitive function compared to those who got standard prehabilitation guidance.
The coached group also showed dramatic changes in their immune function. Patients who received the personalized prehabilitation showed dampened proinflammatory immune pathways compared to the study participants who got the standard pre-operative guidance. “When we started measuring how these interventions change a patient’s immune system, that’s when things got really exciting,” Brice Gaudilliere, Stanford immunologist and a co-author, said in a statement.
The path of recovery from surgery is intimately linked to immune cell function. These cells help repair the damage done by surgery and speed along the healing process. People who are in a state of heightened immune response before surgery, for example due to inflammation, are more likely to suffer infections resulting from operations, the authors note. With immune systems already in overdrive, it’s thought that they are less equipped to react to any new pathogens introduced during surgery.
The study results, which support previous research into prehab, suggest that personalized prehab prepares bodies to deal with new invaders and surgical trauma by muting pre-surgery inflammation and calming reactive immune cells needed for recovery. With an effective, coached period of prehab, patients’ adaptive immune systems—especially adaptive immunity components such as T cells—seemed readier for post-surgery healing.
The researchers equate prehab with training for a marathon, for “not just your physical resilience, but also your immunological, neurocognitive, and psychological state,” added Gaudilliere. 
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