Clinical innovation network analysis (CINA) and readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review

Abstract Introduction Increasing numbers 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 31st December 2021 (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. The WHO framework for monitoring and evaluating DHIs was used for narrative synthesis. Results Seventy-five novel DHIs were identified from 7,605 records. Of these, 76.0% (n= 57/75) were classed as early-stage innovations (IDEAL stage 1 & 2a), and none had achieved routine implementation. There is limited evidence of collaboration based on co-authorship or citations, with 91.3% (n=63/69) of studies beyond IDEAL stage 1 without prior publications. There were notable differences in evaluation, with clear omissions in evaluation across all use-cases: more than 4/5 studies did not consider the feasibility, accessibility, or impact of these interventions on the cost, efficiency or quality of care. Conclusion Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.