Digital health interventions for perioperative patient-reported outcomes: a network meta-analysis

Digital health interventions (DHIs), delivered via digital platforms such as internet-based programs, mobile applications or short messages, may improve patient-reported outcomes (PROs), but comparative effectiveness is unclear. We conducted a network meta-analysis of randomized controlled trials in adults undergoing elective surgery under general anesthesia, identified in PubMed, Embase, CENTRAL, and Web of Science to March 1, 2025. Standardized mean differences (SMDs), mean differences (MDs) with minimal important differences (MIDs), and 95% CIs were estimated. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Fifty-six trials (6,154 patients) were included. Extended reality (XR) most effectively reduced perioperative anxiety (SMD 0.60; 95% CI 0.37-0.84; MD 8.05; MID 6.71; moderate-certainty). For postoperative pain, mobile applications (SMD 0.64; 95% CI 0.32-0.95; MD 1.36; MID 1.0; moderate-certainty) and XR (SMD 0.51; 95% CI 0.26-0.76; MD 1.09; MID 1.0; moderate-certainty) were probably effective. For quality of life, 2D video yielded the greatest gain (SMD 0.99; 95% CI 0.11-1.88; MD 0.11; MID 0.05; high-certainty). XR also improved satisfaction (SMD 1.27; 95% CI 0.63-1.91; MD 1.91; MID 0.75; moderate-certainty). These findings suggest that DHIs may improve perioperative PROs.