Purpose: Patient-initiated follow-up (PIFU) is an emerging model of outpatient care that allows patients to initiate follow-up appointments based on their perceived need, rather than attending routine clinician-led appointments. While well-established in rheumatology and inflammatory bowel disease clinics, its effectiveness in surgical specialties remains unclear. This systematic review evaluates the impact of PIFU in surgical secondary care. Methodology: A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published in PubMed, MEDLINE, Embase, and Scopus between 2014 and 2024 were retrieved. Primary outcomes included changes in outpatient appointment volume, and patient-reported quality of life. Results: Fifty-nine studies were included in this review. Studies across various specialties, including colorectal, breast, and urological surgery, reported fewer hospital visits and enhanced patient autonomy with PIFU. Patients reported that they valued the flexibility and convenience of PIFU, while healthcare providers acknowledged its potential to reduce clinic burden but emphasize the necessity for appropriate patient selection, comprehensive support, and effective monitoring systems. Economic analyses suggest cost savings associated with PIFU implementation, particularly when integrated with digital health solutions. Conclusion: PIFU is a promising approach to optimizing secondary care follow-up in surgical specialties. Further research with standardized implementation strategies and long-term follow-up is required to validate these findings and implement into clinical practice.