The Effect of Perioperative E-Health Interventions on the Postoperative Course: A Systematic Review of Randomised and Non-Randomised Controlled Trials

Abstract

BackgroundE-health interventions have become increasingly popular, including in perioperative care. The objective of this study was to evaluate the effect of perioperative e-health interventions on the postoperative course.MethodsWe conducted a systematic review and searched for relevant articles in the PUBMED, EMBASE, CINAHL and COCHRANE databases. Controlled trials written in English, with participants of 18 years and older who underwent any type of surgery and which evaluated any type of e-health intervention by reporting patient-related outcome measures focusing on the period after surgery, were included. Data of all included studies were extracted and study quality was assessed by using the Downs and Black scoring system.FindingsA total of 33 articles were included, reporting on 27 unique studies. Most studies were judged as having a medium risk of bias (n = 13), 11 as a low risk of bias, and three as high risk of bias studies. Most studies included patients undergoing cardiac (n = 9) or orthopedic surgery (n = 7). All studies focused on replacing (n = 11) or complementing (n = 15) perioperative usual care with some form of care via ICT; one study evaluated both type of interventions. Interventions consisted of an educational or supportive website, telemonitoring, telerehabilitation or teleconsultation. All studies measured patient-related outcomes focusing on the physical, the mental or the general component of recovery. 11 studies (40.7%) reported outcome measures related to the effectiveness of the intervention in terms of health care usage and costs. 25 studies (92.6%) reported at least an equal (n = 8) or positive (n = 17) effect of the e-health intervention compared to usual care. In two studies (7.4%) a positive effect on any outcome was found in favour of the control group.ConclusionBased on this systematic review we conclude that in the majority of the studies e-health leads to similar or improved clinical patient-related outcomes compared to only face to face perioperative care for patients who have undergone various forms of surgery. However, due to the low or moderate quality of many studies, the results should be interpreted with caution.

Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial

“…To our knowledge, there are 13 other studies which have evaluated an educational or supportive eHealth intervention in perioperative care [16,46,50-61]. Most of these studies were relatively small or did not perform a power calculation.…”

European Hernia Society (EHS) guidance for the management of adult patients with a hernia during the COVID-19 pandemic

“…Access to follow-up clinic in terms of transport and clinic availability is an issue. Currently, there are a number of reports relating to post-operative interventions in abdominal wall surgery showing promising results on recurrence detection [24], wound complications [25], and patientreported outcomes [26] using smartphone technology. These could be useful to reduce the need for supplementary access to the hospital after hernia repair and help screen those who do require to be seen.…”

Telemedicine in patients with peripheral arterial disease: is it worth the effort?

“…Two reviewers (MH, RB) independently evaluated the study quality, and discrepancies were discussed until consensus was reached. The thresholds used to classify study quality were good (9-16), moderate (17)(18)(19)(20)(21)(22)(23), and poor (below 14) [6].…”

“…Telemedicine can be divided into educational or supportive websites, telecoaching, telemonitoring, telerehabilitation, and teleconsultation [6]. Various aspects, such as telemonitoring, telecoaching, and teleconsultation, can be potentially important tools in the treatment of patients with peripheral arterial disease (PAD).…”