Advancing health equity along the surgical care pathway: a scoping review of surgical practice guidelines

BACKGROUND: The extent to which surgical guidelines address health inequities remains unclear. We evaluated the inclusion of health equity-relevant recommendations in surgical guidelines and their distribution across the surgical care pathway. METHODS: We searched PubMed, Embase, Web of Science, among others for Canadian, United States, and international surgical guidelines published in English between 2020 and 2025. We identified equity-relevant recommendations using the PROGRESS-Plus framework and mapped them to stages of the surgical care. RESULTS: Among 264 surgical guidelines, 62 (23.5%) included at least one equity-relevant recommendation. Of 2617 recommendations, 277 (10.6%) addressed health equity. Recommendations most frequently addressed sex and older age and were mainly directed towards surgical and post-surgical care, with limited attention to provider access and progression to surgery. CONCLUSIONS: Equity-relevant recommendations are uncommon in surgical guidelines and are focused on downstream surgical care, which may limit guidance for surgeons wishing to address inequities earlier in the surgical care pathway.