Disparities in surgical access: a systematic literature review, conceptual model, and evidence map

de Jager, Elzerie; Levine, Adele A.; Udyavar, Rhea N.; Burstin, Helen R.; Bhulani, Nizar; Hoyt, David B.; Ko, Clifford Y.; Weissman, Joel S.; Britt, L. D.; Haider, Adil H.; Maggard-Gibbons, Melinda A.

doi:10.1016/j.jamcollsurg.2018.12.028

Cited by 178Health disparities and outcomesHealthcare Policy and ManagementGlobal Health and Surgery

Disparities in surgical access: a systematic literature review, conceptual model, and evidence map

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de Jager, Elzerie, Levine, Adele A., Udyavar, Rhea N., Burstin, Helen R., Bhulani, Nizar, Hoyt, David B., Ko, Clifford Y., Weissman, Joel S. +3 more·2019·Journal of the American College of Surgeons

DOI 10.1016/j.jamcollsurg.2018.12.028PMC PMC6391739

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Abstract

[Extract] Healthcare disparities in quality represent one of the greatest challenges in achieving uniformly high-quality care. Research reporting disparities in surgical outcomes are abundant. The cornerstone of delivering high-quality healthcare is ensuring optimal access for all patients. A relative lack of access to surgical services might be a contributing factor to disparities in surgical outcomes. Access is "the timely use of personal health services to achieve the best possible outcomes." Use of services, the process of entering and staying in the system, and the actual quality of care received are all involved. Disparities in access arise when the system disproportionately underperforms for a specific group of patients relative to the historically advantaged population.8, 9 Surgery, because of its time sensitive, often high-acuity nature, is greatly dependent on access.

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In other studies, surgical disparities persist when controlling for social determinants and insurance variables, suggesting additional unknown mechanisms drive observed disparities.
“In others, surgical disparities persist when controlling for these variables, suggesting that there are additional, unknown mechanisms driving observed disparities that warrant closer examination.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [2]
The Discussion says some studies adjust for confounding social determinants and describes multiple possible causes of surgical-access disparities. It does not say that disparities persisted after adjustment for social determinants and insurance, or identify such persistence as evidence of unknown mechanisms. No page number is available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Differential access to specialty care can drive surgical disparities.
“Differential access to specialty care can drive surgical disparities.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [2]
The selection of covariates was made a priori based on factors known to influence interhospital transfer.
“The selection of covariates was made a priori based on factors known to influence IHT.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [2]
The Methods (Data extraction and analysis; page unavailable) describe extracting and categorizing measures of surgical-access disparities, not selecting covariates for an interhospital-transfer analysis. The Results (Provider Access; page unavailable) discuss access to surgical providers but do not identify factors known to influence interhospital transfer. Searches for “interhospital transfer,” “IHT,” and “a priori covariates” found no passage addressing the claim. (LLM, conf=0.75)
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AAA Repair: Sociodemographic Disparities in Management and Outcomes
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Disparities in the Use of Minimally Invasive Surgery for Colorectal Disease
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Health Disparities Influence Childhood Melanoma Stage at Diagnosis and Outcome
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[7]In: Millman M, ed. Access to Health Care in America. Washington (DC); 1993. 25144064

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Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States
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Authors: de Jager, E., Levine, A. A., Udyavar, R. N., Burstin, H. R., Bhulani, N., Hoyt, D. B., Ko, C. Y., Weissman, J. S., Britt, L. D., Haider, A. H., & Maggard-Gibbons, M. A.
Affiliations: Brigham and Women's Hospital (US)
Council of Medical Specialty Societies (US)
American College of Surgeons (US)
University of California, Los Angeles (US)
Eastern Virginia Medical School (US)
Corresponding author: Maggard-Gibbons, Melinda A.
ORCID: Levine, Adele A.
Burstin, Helen R.
Ko, Clifford Y.
Weissman, Joel S.
Britt, L. D.
Haider, Adil H.
Venue: Journal of the American College of Surgeons
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2019-03
Volume: 228
Issue: 3
Pages: 276-298
ISSN: 1072-7515 (ISSN-L)
DOI: 10.1016/j.jamcollsurg.2018.12.028
PMC: PMC6391739
OpenAlex: W2916916949
Cited by: 178
References: 242
Citations by year: 2026: 24 · 2025: 27 · 2024: 34 · 2023: 21 · 2022: 33 · 2021: 21 · 2020: 13 · 2019: 5
FWCI: 3.83
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American College of Surgeons (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
ResearchOnline at James Cook University (James Cook University) (submittedVersion)
eCommons - AKU (Aga Khan University) (submittedVersion)
eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders: National Institute on Minority Health and Health Disparities (5RO1MD011695-02)
Topics: Social Sciences › Health › Health disparities and outcomes
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
Keywords: surgical access, health care disparities, surgical outcomes, quality of care, underserved populations, conceptual model, evidence map
MeSH terms: Health Services Accessibility, Humans, Surgical Procedures, Operative, United States, Healthcare Disparities

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Disparities in surgical access: a systematic literature review, conceptual model, and evidence map

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