Mobile applications in enhanced recovery after surgery: a systematic review of protocol adherence and outcomes

Abstract

Background: Enhanced recovery after surgery (ERAS) programs are designed to reduce postoperative complications and accelerate recovery. Despite their proven benefits, maintaining patient adherence to these protocols remains a significant challenge. Mobile health (mHealth) applications have been introduced as potential tools to support adherence and improve perioperative outcomes; however, their effectiveness within ERAS pathways has not been clearly established. This review aims to evaluate the impact of mobile applications on protocol compliance, recovery, and clinical outcomes among surgical patients enrolled in ERAS programs. Methods: PubMed, EMBASE, and the Cochrane Library were systematically searched through February 2025 to identify studies comparing ERAS care with and without mobile application support. Due to heterogeneity in study design, outcomes, and app functionalities, a meta-analysis was not performed. The primary outcome was adherence to ERAS protocols. Secondary outcomes included quality of recovery, patient and clinician satisfaction, postoperative complication rates, hospital length of stay (LOS), and readmissions. Results: Eight studies encompassing 1,623 patients were included. Mobile app use was associated with improved adherence to ERAS components, particularly early mobilization and oral intake. Some studies reported higher Quality of Recovery-15 (QoR-15) scores and greater patient satisfaction, although these differences were not always statistically significant. The clinician reported reductions in unnecessary visits and improved communication. No study reported an increased rate of complications. One study found that non-adherent patients had a significantly higher risk of 30-day readmission; another reported reduced infection rates and better pain control. The risk of bias was moderate in most studies. Conclusions: mHealth applications integrated into ERAS protocols may improve adherence, recovery quality, and patient engagement without increasing adverse outcomes. However, the overall quality of evidence remains limited due to heterogeneity and a predominance of non-randomized studies.