Evidence map›Paper›PMID 39753325›Full record

ArticleCanadian journal of surgery. Journal canadien de chirurgie

Rurality predisposes departure from gold-standard care, leading to delayed or accelerated access to surgery: insights from a scoping review.

Alisha Ebrahim, Sarthak Sinha, Ifeoluwa Adedipe, Abeer Ahmad, Madison Amyotte, Lucy Yang, Omar Elsewify, Sukhmeet S Sachal, Frankie O G Fraulin, Vincent A Gabriel and 2 more

Abstract readScoping Review
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of surgery. Journal canadien de chirurgie. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Assessing the urologist workforce in British Columbia Wait times, workload, and burnout in 2022.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Alisha Ebrahim *From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Sarthak Sinha *From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Ifeoluwa Adedipe *From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Abeer Ahmad *From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Madison Amyotte *From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Lucy Yang *From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Omar ElsewifyFrom the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Sukhmeet S SachalFrom the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Frankie O G FraulinFrom the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Vincent A GabrielFrom the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston).
Grace PerezFrom the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston) grace.perez@ucalgary.ca aaron.johnston2@ucalgary.ca.
Aaron JohnstonFrom the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang); the Canadian Global Surgery Trainees' Association affiliated with the International Student Surgical Network - InciSioN (Ebrahim, Sinha, Adedipe, Ahmad, Amyotte, Yang, Elsewify); the Faculty of Medicine and Health Sciences, Laval University, Québec City, Que. (Elsewify); the Division of Plastic and Reconstructive Surgery, University of Western Ontario, London, Ont. (Sachal); the Sections of Pediatric Surgery and Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Fraulin); the Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alta. (Gabriel); the Department of Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Perez, Johnston) grace.perez@ucalgary.ca aaron.johnston2@ucalgary.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBecause tertiary centres are generally situated at urban sites, it is unclear whether patients in rural areas have the same access to surgical services that patients in urban areas do. We sought to map the North American evidence landscape of how rurality affects access to medically indicated surgeries and identify system-, patient-, and provider-level barriers that preclude urban-comparable care.

methodsWe carried out a systematic search adhering to PRISMA for Scoping Reviews methodology across PubMed, MEDLINE, Scopus, and Web of Science, encompassing literature from the last 26 years (January 2023). Search terms included "rural population," "health care access," "surgical procedures," and "health disparities." We synthesized our findings using a narrative approach.

resultsOf 13 897 identified studies, we included 71 publications, spanning a wide spectrum of surgical disciplines. Of these, 83% reported diminished and 17% reported accelerated access to surgery, and 30% reported an interaction between rurality with other social determinants of health, particularly age, sex and gender, and race and ethnicity. Of the studies that reported diminished access, top cited reasons included primary and specialist provider density, differences in patients' socioeconomic profiles, and provision of comparable counselling during surgical decisionmaking. Strikingly, a key driver of enhanced surgical access was an absence of specialized medical interventions leading to an overreliance on surgical alternatives.

conclusionWhether surgical access was diminished or accelerated, the net impact of rurality was a deviation from guideline-concordant care. A key implication of these findings is that reliance on surgical wait times alone can skew perception of surgical access, advocating for adoption of integrated quality-of-care metrics that better reflect access to comprehensive medical and surgical treatment programs. CONTEXTE: Étant donné que les centres de soins tertiaires se trouvent généralement en milieu urbain, on peut se demander si l'accès aux services chirurgicaux est le même en région rurale qu'en milieu urbain. Nous avons voulu cartographier, preuve à l'appui, l'impact de la ruralité sur l'accès à des chirurgies médicalement indiquées en Amérique du Nord et identifier les obstacles, propres au système, à la patientèle et aux équipes soignantes, qui nuisent à la prestation des soins équivalents à ceux des milieux urbains. MÉTHODES: Nous avons procédé à une interrogation systématique (conforme à la Norme de réalisation de revue systématique de la littérature PRISMA) des bases de données PubMed, MEDLINE, Scopus et Web of Science regroupant la littérature des 26 dernières années (janvier 2023). Les mots clés de langue anglaise utilisés incluaient : « rural population », « health care access », « surgical procedures » et « health disparities ». Nous avons synthétisé nos observations au moyen d'une approche narrative. RÉSULTATS: Des 13 897 études recensées, nous avons retenu 71 publications abordant un vaste éventail de disciplines chirurgicales. Parmi ces publications, 83 % faisaient état d'un accès diminué, 17 % d'un accès plus rapide à la chirurgie, et 30 % d'un lien entre la ruralité et d'autres déterminants sociaux de la santé, notamment l'âge, le sexe et le genre, ainsi que la race et l'ethnicité. Selon les études ayant fait état d'un accès diminué, les principales raisons incluaient la densité des effectifs en médecine primaire et de spécialité, les différences de profils socioéconomiques de la patientèle et l'offre d'un counselling comparable lors du processus décisionnel concernant la chirurgie. À noter, l'un des principaux facteurs d'amélioration de l'accès aux soins chirurgicaux était l'absence d'interventions médicales spécialisées associées à une dépendance indue à l'endroit des solutions chirurgicales.

conclusionQue l'accès à la chirurgie ait été diminué ou accéléré, l'impact net de la ruralité a pris la forme d'un écart par rapport aux soins préconisés par les lignes directrices. Ces observations indiquent principalement que la dépendance à l'égard des temps d'attente en chirurgie seule peut fausser la perception quant à l'accès aux soins chirurgicaux, ce qui milite en faveur de l'adoption de paramètres de qualité de soins intégrés qui reflèteraient plus fidèlement l'accès à des programmes de traitements médicaux et chirurgicaux complets.

Indexed as

Health Services AccessibilityRural Health ServicesRural PopulationHealthcare DisparitiesHumansSurgical Procedures, Operative

Identifiers

PMID39753325
PMCPMC11684926

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.