Perioperative Care Pathways in Low- and Lower-Middle-Income Countries: Systematic Review and Narrative Synthesis

Area of Science:

• Global Health
• Surgical Care
• Health Systems Research

Background:

• High-quality perioperative care is crucial for surgical patients.
• Care pathways standardize practice and improve outcomes in high-income countries.
• Perioperative mortality is significantly higher in low- and middle-income countries (LMICs).

Purpose of the Study:

• To identify and describe studies on perioperative care pathway implementation in LMICs.
• To synthesize findings on settings, outcomes, strategies, facilitators, and barriers.
• To understand the current landscape of perioperative care pathway use in resource-limited settings.

Main Methods:

• Systematic review and narrative synthesis of peer-reviewed journal articles.
• Comprehensive database searches including MEDLINE, EMBASE, and WHO Global Index.
• Descriptive statistics, taxonomy, and framework analyses for data summarization.

Main Results:

• Twenty-seven studies were included, mostly in lower-middle-income countries and focused on elective surgery.
• Few studies (6) were high quality; most pathways were adapted and single-hospital implementations.
• Common barriers included intervention costs and lack of resources.

Conclusions:

• Perioperative pathways are adapted for resource-poor settings in LMICs, but literature from low-income countries and emergency surgery is sparse.
• Addressing patient and clinician beliefs remains a significant challenge.
• Context-relevant, patient-centered research, including qualitative and implementation studies, is needed.