Objective:

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

Approach:

• Study Design: Retrospective, single-center, pre- and postintervention study conducted in a high-volume tertiary hospital.
• Participants: Consecutive adult patients undergoing elective pelvic gynecological surgery by a single experienced surgeon between February 2024 and January 2025.
• Intervention: Implementation of a digital perioperative pathway incorporating prehabilitation modules, structured education, rehabilitation guidance, and electronic patient-reported outcomes (ePROs) during the fourth quarter of the study.
• Endpoints: Primary endpoint was the 90-day readmission rate; secondary endpoints included length of stay (LOS) and high-grade postoperative complications.

Key Findings:

• Atotalof426patientswereanalyzed,including313inthepreimplementationgroupand113inthepostimplementationgroup.The90-dayreadmissionratedecreasedfrom12.8%beforeimplementationto8.8%afterimplementation(34%relativereduction,p=0.17).High-gradecomplicationsdecreasedfrom1.6%to0.9%(p=0.5).Overalllengthofstayremainedstableat0.86days,withasame-daydischargerateof54.2%.Comparisonwithnationaldatashowedamorefavorablepostoperativeprofileintermsofsame-daydischargerate(p=0.004)andreadmissionrate(p<0.001).

Interpretation:

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.

Limitations:

• Retrospective study design may introduce bias.
• Single-center study limits generalizability.
• Statistical significance not achieved for some outcomes.

Conclusion:

The findings warrant further investigation.