Abstract
Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of high-quality evidence is often cited as a barrier to DHI implementation. This review captures and appraises the current use, evidence base and reporting quality of mobile and wearable DHI following surgery. Keyword searches were performed within Embase, Cochrane Library, Web of Science and WHO Global Index Medicus databases, together with clinical trial registries and Google scholar. Studies involving patients undergoing any surgery requiring skin incision where postoperative outcomes were measured using a DHI following hospital discharge were included, with DHI defined as mobile and wireless technologies for health to improve health system efficiency and health outcomes. Methodological reporting quality was determined using the validated mobile health evidence reporting and assessment (mERA) guidelines. Bias was assessed using the Cochrane Collaboration tool for randomised studies or MINORS depending on study type. Overall, 6969 articles were screened, with 44 articles included. The majority (n = 34) described small prospective study designs, with a high risk of bias demonstrated. Reporting standards were suboptimal across all domains, particularly in relation to data security, prior patient engagement and cost analysis. Despite the potential of DHI to improve postoperative patient care, current progress is severely restricted by limitations in methodological reporting. There is an urgent need to improve reporting for DHI following surgery to identify patient benefit, promote reproducibility and encourage sustainability.
Highlights
The worldwide use of surgical treatments is increasing, with approximately one in ten people undergoing a surgical procedure each year in high-income countries[1,2]
Studies have already demonstrated that using digital health interventions (DHI) can help identify postoperative complications earlier, improve recovery, and provide safe follow-up which is acceptable to patients[10,14,15,16,17,18]
Additional primary outcomes included the impact of DHI on pain management[33,34,44,46], postoperative complications[50,51,58,60,68], symptom monitoring[36,40], surgical site infection[35,47,55,62,69,70] and hospital resource use[23,35,39,45,63]
Summary
The worldwide use of surgical treatments is increasing, with approximately one in ten people undergoing a surgical procedure each year in high-income countries[1,2]. Studies have already demonstrated that using digital health interventions (DHI) can help identify postoperative complications earlier, improve recovery, and provide safe follow-up which is acceptable to patients[10,14,15,16,17,18]. Embedded sensors in mobile phones and wearable technology can capture data remotely, passively and continuously, providing opportunities to track physiological parameters and enable patients to self-report symptoms and signs, which can indicate their postoperative status. DHI may include wearable activity trackers[20], mobile phone applications[21], realtime collection of patient-reported outcomes[22] and/or multiple electronic devices forming a digital health kit[23]
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