Strategies and Recommendations to Improve Accessibility of Essential Surgery in Rural Settings in OECD Countries: A Scoping Review.

Abstract

The provision of essential and emergency surgical services presents complex challenges in remote areas. Equitable access has gained attention thanks to the significant work done by the Lancet Commission on Global Surgery (LCoGS). Although the focus was on low- and middle-income countries, developed countries also face challenges in providing equitable surgical care and, in fact, do not always meet the benchmarks set by the LCoGS yet still have acceptable outcomes. We sought to explore the current strategies aimed at improving and maintaining access to essential surgical care in rural and remote areas of OECD countries (Organization for Economic Co-operation and Development). We conducted a scoping review using MeSH terms. The search was performed on MEDLINE and EMBASE databases and was limited to English sources published between 1946 and January 10, 2025. Any strategy or intervention aimed at improving and maintaining timely access to essential surgeries in rural and remote areas of OECD countries. Six main categories of strategies were found: (1) resource distribution; (2) task sharing; (3) telemedicine; (4) surgical workforce; (5) training and education; and (6) prehospital system. Recognizing that developed countries, in fact, do not always meet the benchmarks set by the LCoGS yet still have acceptable outcomes highlights that specific strategies are important contributors to the reduction of disparities between rural and urban outcomes. These strategies may be used in the study of surgical services in low- and middle-income countries.