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Post discharge digital health technology interventions in ambulatory surgery: A systematic review and meta-analysis
Signe Berit Bentsen1, Mi Stjernberg, Johan Ræder
1From the Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway (SBB, GEE, PAH), the Department of Operating Services, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway (SBB), the Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway (MS), the Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway (MS, JR), the Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway (MS), the Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway (JR), the Library, Western Norway University of Applied Sciences, Bergen, Norway (MNT), the Section for Competence and Education, Førde Central Hospital, Førde, Norway (PAH).
Background:
Given the early discharge associated with ambulatory surgery, digital health interventions (DHIs) may be useful in out of hospital follow-up. However, there are no systematic reviews concerning the use of DHIs in this setting.
Objective:
To identify and evaluate the effects of DHIs on, patient safety, patient experience, and efficiency in post discharge ambulatory surgery.
Design:
Systematic review and meta-analysis. Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation were used.
Data Sources:
MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus were systematically searched from inception to 9 October 2024.
Eligibility Criteria:
Randomised controlled trials (RCTs); ambulatory surgical patients ≥18 years; post discharge digital health interventions, including but not limited to computer tablets, mobile applications, and smart phones. Control group interventions included post discharge follow-up by a general practitioner, office-based follow-up, telephone follow-up, or no intervention.
Results:
Six RCTs, with a total of 1397 patients were included. The meta-analyses showed no significant effects of DHIs compared with control group interventions on average pain intensity during postoperative days one to three, standardised mean difference = -0.15 (95% CI, -0.66 to 0.35), P = 0.556, or on unplanned healthcare encounters up to six months postoperatively, relative risk = 0.98 (95% CI, 0.92 to 1.05), P = 0.580. A review of individual articles showed that patients in the DHI groups reported significantly less impaired sleep, mood swings, stress, dizziness, headaches, sore mouth, constipation, and wound-related problems. Additionally, costs were lower, and patients reported improved functional status and well being compared with the control group. The risk of bias varied from low to moderate and the quality of evidence was low.
Conclusions:
Digital health interventions may reduce some symptoms and costs following discharge from ambulatory surgery, while improving quality of life. However, uncertainty remains due to the limited number of studies, some inconsistent results, and the low certainty of evidence.
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