Impact of a digital pre- and rehabilitation program on postoperative outcomes after pelvic gynecological surgery

Growing evidence suggests that structured preoperative education and close postoperative monitoring improve surgical outcomes. Digital health solutions may facilitate the large-scale implementation of perioperative optimization pathways by integrating prehabilitation, patient education, and remote monitoring into routine care.

To evaluate the impact of implementing a comprehensive digital perioperative coaching program (BETTY) on postoperative outcomes in patients undergoing elective pelvic gynecological surgery.

This retrospective, single-center, pre- and postintervention study was conducted in a high-volume tertiary hospital. Consecutive adult patients undergoing elective pelvic gynecological surgery by a single experienced surgeon between February 2024 and January 2025 were included. During the fourth quarter of the study period, a digital perioperative pathway incorporating prehabilitation modules, structured education, rehabilitation guidance, and electronic patient-reported outcomes (ePROs) was implemented. The primary endpoint was the 90-day readmission rate. Secondary endpoints included length of stay (LOS) and high-grade postoperative complications. Outcomes before implementation (Q1-Q3) were compared with those after implementation (Q4).

A total of 426 patients were analyzed, including 313 in the preimplementation group and 113 in the postimplementation group. Baseline characteristics and surgical complexity were comparable between groups. The 90-day readmission rate decreased from 12.8% before implementation to 8.8% after implementation, corresponding to a 34% relative reduction (p = 0.17). High-grade complications decreased from 1.6% to 0.9% (p = 0.5). Overall length of stay remained stable (0.86 days), with a same-day discharge rate of 54.2%. Comparison with national data confirmed the more favourable post-operative profile in terms of same-day-discharge rate (p = 0.004) and readmission rate (p < 0.001).

The implementation of a structured digital perioperative pathway integrating prehabilitation and remote monitoring was associated with lower readmission and complication rates after pelvic gynecological surgery. Although differences did not reach statistical significance, the magnitude of effect suggests potential clinical relevance and supports further prospective evaluation.