Implicit bias in surgical decision-making: a scoping review of recommendations, timing, and access to operative care

Surgical disparities are well documented, yet the extent to which implicit biases influence surgical decision-making remains incompletely characterized. A PRISMA-ScR–aligned scoping review of PubMed, Embase, CINAHL, PsycINFO, and Web of Science (2013–2025) with grey literature screening was conducted. Studies were included if they evaluated implicit bias in surgical decision-making, including operative recommendation, timing/prioritization of procedures, or candidacy for surgery. A total of 1,849 records were identified with 1,613 remaining after duplicate removal. 36 articles underwent full-text review and 26 met inclusion criteria. Studies spanned multiple specialties and clustered into three decision domains: operative recommendation ( n = 18), timing/prioritization of surgery ( n = 5), and candidacy/access to surgery ( n = 3). Disparities were frequently observed at points where clinical guidance was less explicit. Evidence suggests disparities cluster at discretionary surgical decision nodes, particularly in operative recommendation, timing, and access. Identifying these points may help guide measurement strategies and structural interventions to reduce care inequities.