Omar Dewidar, Mouad Elganga, Bahaaldin Helal, Ashlee Chan, Mohamed Tarek Madani, Daniel Bour, Pierre Ibrahim, Youssef El-Feki, Mostafa Bondok, Abdul Rahman Al Kos, Andrea J Darzi, Vivian Welch, Emily Pearsall, Sarah Ward
Equity-relevant recommendations are uncommon in surgical guidelines and are focused on downstream surgical care, which may limit guidance for surgeons wishing to address inequities earlier in the surgical care pathway.
BACKGROUND: The extent to which surgical guidelines address health inequities remains unclear. We evaluated the inclusion of health equity-relevant recommendations in surgical guidelines and their distribution across the surgical care pathway.
METHODS: We searched PubMed, Embase, Web of Science, among others for Canadian, United States, and international surgical guidelines published in English between 2020 and 2025. We identified equity-relevant recommendations using the PROGRESS-Plus framework and mapped them to stages of the surgical care.
RESULTS: Among 264 surgical guidelines, 62 (23.5%) included at least one equity-relevant recommendation. Of 2617 recommendations, 277 (10.6%) addressed health equity. Recommendations most frequently addressed sex and older age and were mainly directed towards surgical and post-surgical care, with limited attention to provider access and progression to surgery.
CONCLUSIONS: Equity-relevant recommendations are uncommon in surgical guidelines and are focused on downstream surgical care, which may limit guidance for surgeons wishing to address inequities earlier in the surgical care pathway.