Digital Health Interventions and Postoperative Outcomes in Elective Surgery: Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Digital health interventions are widely promoted to reduce postoperative morbidity, but evidence remains fragmented across specialties and modalities, and randomized and nonrandomized data have often been pooled without distinction. OBJECTIVE This study aimed to determine whether digital health interventions reduce postoperative complications and unplanned readmissions compared with standard in-person care after elective surgery. METHODS PubMed/MEDLINE, Embase, and Scopus were searched to May 31, 2026, for prospective randomized and nonrandomized comparative studies of digital health interventions vs in-person care in adults undergoing elective nonorthopedic surgery. Co-primary outcomes were any complication and unplanned readmission within 30 days; severe complications (Clavien-Dindo grade ≥III) were the prespecified secondary outcome. Odds ratios (ORs) were pooled in random-effects models, with a preplanned sensitivity analysis restricted to randomized trials. Risk of bias was assessed with RoB 2 and ROBINS-I, and certainty of evidence with GRADE. RESULTS Twenty-nine studies (5288 patients; 23 randomized trials; 9 specialties) were included. Overall, digital health interventions did not differ from in-person care for any complication (k=12; OR 0.87, 95% CI 0.59-1.29; P=.46) or readmission (k=14; OR 0.72, 95% CI 0.52-1.02; P=.06), and were favored for severe complications (k=7; OR 0.62, 95% CI 0.39-0.99; P=.047). Restricted to randomized trials, no significant difference was observed for any outcome (any complication: OR 1.01, 95% CI 0.62-1.66; severe complications: OR 0.68, 95% CI 0.35-1.32; readmission: OR 0.85, 95% CI 0.56-1.27). In the narrative synthesis, digital interventions were most often reported to improve patient-reported outcomes and satisfaction, and no study favored in-person care for any safety outcome. CONCLUSIONS Digital perioperative programs achieve surgical outcomes comparable to standard in-person care. Their value lies in delivering equivalent care more efficiently, with remote monitoring for the early detection of postdischarge complications as the most promising application, rather than in reducing overall surgical morbidity.