Conceptualizing surgical ageism to address age-based discrimination

Ageism is an underrecognized form of discrimination that compromises equity, autonomy, and health outcomes for older adults. Inappropriate age-based assumptions can result in the underutilization of beneficial procedures, delayed interventions, and inequitable resource allocation. To conceptualize ageism in surgery by exploring its cognitive, systemic, and ethical underpinnings, and to propose actionable strategies to mitigate its impact on surgical decision-making and patient care. Through a conceptual framework, data from epidemiological studies, clinical trials, systematic reviews, and health policy reports were synthesized, providing proof for physicians' attitudes, systemic practices and ethical frameworks in perpetuating surgical ageism. Proof that cognitive biases can fuel ageism in surgery was demonstrated across multiple studies involving over 149,000 participants and more than 30 individual studies, each highlighting distinct biases that skew surgical decision-making, especially for older adults. Proof that systemic inequities contribute to surgical ageism was evidenced by studies on transplant referral, clinical trial exclusion, and ethical resource allocation frameworks, involving over 24,000 participants and multiple large-scale reviews. Finally, evidence supporting that educational strategies can mitigate ageism and the need for anti-ageism measures, was drawn from a range of studies involving over 20,000 participants across at least 80 studies. Surgical ageism stems from a confluence of cognitive, structural, and cultural factors. By addressing the drivers of ageism and implementing inclusive policies, the surgical community can promote person-centred care and uphold the dignity and rights of older adults in line with global health equity goals.