Abstract
Background: An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have recently been developed and evaluated. We aimed to review DHIs for postoperative monitoring and evaluate their readiness for implementation into routine care.
Methods: This systematic review identified studies on implementation and evaluation of DHIs for postoperative monitoring published before 1st December 2022 (PROSPERO ID: CRD42021264289). Studies which included postoperative monitoring use-cases for general postoperative recovery or specific complications were defined according to their IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) stages of innovation. A novel clinical innovation network analysis (CINA) using co-authorship and citations of previous work was used to examine collaboration and progression within the field. The WHO framework for monitoring and evaluating DHIs was used for the thematic narrative synthesis.
Findings: There were 126 studies of 100 novel DHIs identified from 8,591 records. Of these studies, 80.2% (n=101/126) were classed as at an early stage of innovation (IDEAL stage 1 & 2a), and only 1 had achieved routine implementation at a single centre. There is limited evidence of collaboration based on co-authorship or reference to previous work, with 90.7%, n=107/118 of studies beyond IDEAL stage 1 without prior stages published. There were notable differences in evaluation across IDEAL stages, with clear omissions in evaluation across all use-cases: more than 4/5 studies did not consider the feasibility, accessibility, or the impact of these interventions on the cost, efficiency or quality of care.
Interpretation: Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
Methods: This systematic review identified studies on implementation and evaluation of DHIs for postoperative monitoring published before 1st December 2022 (PROSPERO ID: CRD42021264289). Studies which included postoperative monitoring use-cases for general postoperative recovery or specific complications were defined according to their IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) stages of innovation. A novel clinical innovation network analysis (CINA) using co-authorship and citations of previous work was used to examine collaboration and progression within the field. The WHO framework for monitoring and evaluating DHIs was used for the thematic narrative synthesis.
Findings: There were 126 studies of 100 novel DHIs identified from 8,591 records. Of these studies, 80.2% (n=101/126) were classed as at an early stage of innovation (IDEAL stage 1 & 2a), and only 1 had achieved routine implementation at a single centre. There is limited evidence of collaboration based on co-authorship or reference to previous work, with 90.7%, n=107/118 of studies beyond IDEAL stage 1 without prior stages published. There were notable differences in evaluation across IDEAL stages, with clear omissions in evaluation across all use-cases: more than 4/5 studies did not consider the feasibility, accessibility, or the impact of these interventions on the cost, efficiency or quality of care.
Interpretation: Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
| Original language | English |
|---|---|
| Pages (from-to) | e295-e315 |
| Journal | The Lancet Digital Health |
| Volume | 5 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 31 May 2023 |