Measuring Value in Surgery: A Scoping Review of Economic Indices Across Specialties

Escalating health-care costs and increasing patient complexity underscore the need for standardized, comparable measures of surgical value. Despite numerous proposed indices, methodological heterogeneity limits cross-specialty comparison. This scoping review aims to (1) characterize trends in value index utilization, (2) assess variability in index components, (3) identify specialty-specific and bibliometric patterns, and (4) propose a preliminary conceptual model to guide index selection.

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews-guided scoping review of PubMed, Embase, and Google Scholar (July 2025) identified 2015-2025 studies evaluating surgical value. Eligible English-language, peer-reviewed studies applied quantitative value indices, while reviews, case reports, and nonoperative studies were excluded. Two reviewers screened independently, and data on specialty, index type, and components were extracted. Bibliometric analysis mapped keyword clusters and citation trends.

Of 342 included studies, 11 distinct indices were identified. The most frequently reported indices were incremental cost-effectiveness ratio (n = 189, 55.3%), time-driven activity-based costing (n = 93, 27.2%), and net monetary benefit (n = 27, 7.9%), followed by return on investment (n = 23, 6.7%) and operative value index (n = 6, 1.8%); net health benefit, net present value, and procedure value index each accounted for under 1% of studies (n ≤ 6). General, orthopedic, and cardiothoracic surgery were the most represented specialties. Bibliometric analysis identified orthopedic-predominant keyword clusters and citation bursts in replacement and quality of life. Substantial heterogeneity in index selection across specialties motivated development of a preliminary conceptual model for index selection.

This first scoping review of surgical value metrics reveals pervasive heterogeneity and introduces a preliminary conceptual model intended to organize index selection and motivate future validation efforts toward comparable, evidence-based value assessment.