Digital Health Interventions targeting patient-led ERAS Behaviours across Perioperative Care Pathways: A Systematic Review
This systematic review of seven studies suggests that while digital health interventions show promise in reducing hospital length of stay and improving mobilization adherence for Enhanced Recovery After Surgery (ERAS) protocols, evidence regarding their impact on other clinical and patient-reported outcomes remains uncertain due to methodological heterogeneity and inconsistent findings.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every year, more than 300 million surgeries are performed around the world. For the patient, the goal is simple: to heal quickly and return to a normal life. For the hospital, the goal is equally practical: to ensure the patient recovers safely without staying longer than necessary. To bridge the gap between the operating room and a full recovery, doctors use a set of rules called Enhanced Recovery After Surgery, or ERAS. These rules are a checklist of actions designed to speed up healing. Some parts of the checklist are handled by the medical team, such as managing fluids during the operation. Other parts rely entirely on the patient, such as getting out of bed to walk as soon as possible, eating and drinking early, and managing pain without overusing strong medications.
While the medical team usually follows their part of the plan very well, patients often struggle to keep up with their own tasks. Pain, confusion, or old habits like staying in bed can get in the way. When patients do not follow the rules, recovery can stall, leading to longer hospital stays and more complications. In recent years, hospitals have begun using digital tools, like smartphone apps or interactive television screens, to help patients remember what to do and to encourage them to stay on track. The question facing researchers is whether these digital helpers actually work better than standard care.
A team of researchers from the University of Newcastle in Australia set out to find the answer. They conducted a systematic review, which is a method of gathering and carefully examining every available study on a specific topic to see what the total evidence says. They searched through thousands of research papers and selected seven studies that tested digital health tools designed to help patients follow their ERAS rules. These studies involved patients undergoing major surgeries, including colorectal surgery, hip replacements, and knee replacements. The digital tools varied; some were mobile apps that sent reminders and allowed patients to check off daily goals, while others were interactive screens in hospital rooms that showed videos and animations about how to recover.
The researchers looked at two main things: whether the digital tools helped patients actually do the tasks they were supposed to do, and whether these tools changed the length of time patients spent in the hospital. When it came to the patients' behavior, the results were mixed but showed a clear pattern for one specific task. In every study that measured whether patients got out of bed and moved around, the group using the digital tools did better than the group receiving standard care. In two of these studies, the improvement was statistically significant, meaning the difference was unlikely to be due to chance. However, for other tasks, such as eating solid food or taking medication, the results were less consistent. Some studies showed improvement, while others showed no difference at all. This suggests that while digital tools are very good at prompting patients to move, they are not a magic solution for every part of the recovery checklist.
The findings regarding hospital stays were more encouraging. Every single study that reported the average number of days patients stayed in the hospital found that the group using the digital tools stayed for a shorter time. The reduction ranged from less than one day to two full days. In four of the studies, this reduction was statistically significant. This is a meaningful result because even a small reduction in hospital time can free up beds for other patients and reduce costs for the healthcare system. However, the researchers noted that the evidence for this finding is not yet ironclad. Some studies reported the data in ways that made it hard to compare them directly, and some had flaws in their design, such as not following all the patients they started with. Because of these issues, the researchers described the certainty of the evidence as low, meaning that while the results look promising, more high-quality research is needed to confirm them.
The review also looked at other outcomes, such as whether patients were readmitted to the hospital, whether they had complications like infections, or whether they felt their quality of life improved. Here, the digital tools did not show a clear advantage. The rates of readmission and complications were similar between the groups using the tools and those who did not. Similarly, the impact on how patients felt about their recovery was inconsistent; some studies showed a slight improvement in satisfaction, while others showed no change at all. The researchers explained that these outcomes are harder to influence with a simple app or screen, as they depend on many complex factors beyond just patient behavior.
Ultimately, this review suggests that digital health tools are a useful addition to surgical care, particularly for getting patients moving again after surgery. They appear to be effective at shortening the average time a patient spends in the hospital, which is a significant benefit for both the individual and the healthcare system. However, the tools are not a cure-all. They do not guarantee that patients will eat better or take their medicine correctly, nor do they automatically prevent complications. The researchers conclude that these tools should be integrated thoughtfully into hospital care, tailored to the specific needs of patients and the local medical team. While the current evidence is promising, the path forward requires more rigorous studies to understand exactly which parts of these digital tools work best and how they can be improved to help patients recover fully.
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