Impact of climate change on surgery: A scoping review to define existing knowledge and identify gaps.

With climate change accelerated at a worrisome rate, global warming also will have implications for surgery and surgical practice. The goal of this current study was to systematically survey the literature and better understand how climate change has affected surgical disease burden, surgical care delivery, and surgical outcomes. We performed a comprehensive scoping review, screening 3334 unique citations from three databases - 1766 from Embase, 1329 from Pubmed and 239 from Scopus - to identify studies that had associated climate change with surgery. After systematic searching, quality appraisal, and data extraction, we synthesized findings from qualitative and quantitative studies. Twenty-six studies that met the inclusion criteria were included in the review. The studies associating climate change with surgery spanned all surgical subspecialties, although most notable examples came from urology, trauma surgery, and burns and reconstructive surgery. Although there is increasingly strong evidence for how climate change might affect surgery, there is a paucity of research attempting to establish a more direct correlation or causal link between the two. Additionally, we identified several studies that did not directly address climate change but instead focused on chronobiology and its effects on surgery, highlighting directions for future research. The existing evidence, despite its limitations, generates hypotheses for future work, implicating climate change as an independent contributor towards increased surgical disease burden, decreased surgical care delivery, and worsened surgical outcomes.