Investigating the Landscape of General Surgical Care in Rural Aotearoa, New Zealand: A Scoping Review.

Objective: This scoping review explores the provision of general surgical services in rural and regional Aotearoa, New Zealand (Aotearoa NZ). Rural and regional populations, particularly Māori, face significant health inequities exacerbated by a shortage of surgeons, limited resources and geographic isolation. Understanding these challenges is critical to improving equitable surgical care. This article aims to identify key factors affecting surgical service delivery in Aotearoa NZ outside of main urban centres, examine existing models of care and explore workforce challenges to inform strategies for equitable service delivery.

Methods: This Scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Database searches (PubMed, Embase, Scopus and CINAHL) used keywords like 'Aotearoa NZ', 'rural', 'general surgery' and 'access'. Articles addressing rural surgical services in Aotearoa NZ were included, excluding case studies and non-relevant subspecialty topics.

Results: Twenty-six articles met the inclusion criteria. Only 14.3% of Aotearoa NZ general surgeons are based in rural regions, despite nearly half of the population residing outside of main centres. Mobile surgical units and outreach services improve access but face challenges in sustainability and scope. Using an adapted framework from the Aotearoa NZ Rural Health Strategy, common barriers to rural general surgical care described include geographic isolation, limited resources and poor workforce retention. Additionally, Māori patients experience disproportionate adverse outcomes, such as longer hospital stays for specific conditions, but there has been little research done in this regard.

Conclusion: Rural and regional surgical care in Aotearoa NZ faces significant inequities in workforce distribution, access and patient outcomes. Strengthening rural training pathways, developing sustainable care models and investing in targeted research are essential steps toward achieving equitable surgical services for rural, regional and Māori populations.