Despite advances in surgical techniques and perioperative care, postoperative complications continue to pose significant challenges, impacting patient outcomes, health care resource utilization, and overall costs [1,2].

A growing body of evidence suggests that patient education before surgery and close monitoring during the postoperative period could improve patients’ outcomes. Ideally, optimized perioperative pathways should encompass a multifaceted approach, addressing various domains to streamline the entire perioperative course and mitigate the incidence and severity of complications. Globally optimized pathways integrating safety checklists, prehabilitation and rehabilitation programs, individualized assessment of patient risk, and remote monitoring are particularly promising. Prehabilitation, which entails comprehensive preparation of patients for the upcoming surgical procedure, coupled with structured rehabilitation programs, can effectively minimize adverse effects, optimize patient health status, and aid recovery after surgery [[3], [4], [5], [6]]. While the benefits of prehabilitation and rehabilitation programs are well established, their implementation in clinical practice has been hindered by various challenges. These include limited access to specialized health care professionals, geographical barriers, and logistical complexities of coordinating and delivering these programs effectively [7]. In addition, checklists have been demonstrated to improve patient safety and reduce avoidable errors. Notably, data indicate that at least half of surgical complications may be avoided [8].

Over the past decade, electronic health (eHealth) has emerged as a promising tool to enhance adherence to educational programs and treatment outcomes, and to overcome organizational and financial constraints that prevented the wide adoption of prehabilitation and rehabilitation programs [9]. Electronic health could facilitate the spread of optimized pathways and at-home recovery, and could also reduce geographic inequalities in access to optimized care. Remote monitoring enables more accurate records of patients’ daily shape, and thus, could help health care delivery and emergency medical care when needed [10]. Telemonitoring could also support the transition to an outpatient recovery pathway [11]. Few randomized control studies investigated the impact of an eHealth program on perioperative outcomes, demonstrating faster recovery periods, but were unable to find a significant advantage in terms of complications [[12], [13], [14], [15]]. Our study aimed to evaluate the impact of the implementation of an optimized digital pathway, gathering prehabilitation and rehabilitation protocols, patient education, checklists, electronic patient-reported outcomes (ePROs) collection, through the use of a new smartphone application.