Health Equity and Emergency Colorectal Surgery in the United States: A Scoping Review

Abstract

Introduction

The emergency colorectal surgery population represents one of the most vulnerable subsets of the larger emergency general surgery population, characterized by increased complication rates, mortality rates, health resource utilization, and hospitalization costs. Disparities and inequities are documented for the emergency general surgery population and its emergency colorectal subset. Addressing health inequities can lead to decreased costs and improvement in patient outcomes; however, it is important to have a full scope of drivers of health inequities in different populations. We summarize the scope of literature that evaluates inequities in patients who undergo emergency colorectal surgery using two equity-based frameworks.

Methods

We conducted a systematic search using Medline, Embase, and Web of Science Core Collection databases. Articles were evaluated for inclusion based on evaluation of disparities, inequities, and social determinants in patients who underwent emergency abdominal colorectal surgery in the United States between 2014 and 2024. We extracted data based on components of the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital) framework and classified studies based on the Phases of Health Disparity Research framework.

Results

Twenty-two articles met inclusion criteria. Race/ethnicity was most commonly evaluated in studies (86%) followed by socioeconomic status/insurance status/income. Sex/gender, social support, language, social support, and religion were less commonly evaluated. The majority of the studies focused on malignant disease were in the detecting phase of disparities research.

Conclusions

Future studies evaluating inequities in the emergency colorectal surgery population should consider a comprehensive analysis of social factors and measures of structural racism.