Disparities in access to and outcomes of minimally invasive surgery: a scoping review
Related Experiment Video
Updated: Jul 1, 2026
Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
Published on: October 17, 2025
Shaneeta Johnson1,2, Zahra A Fazal3, Kelsie Campbell3
1Department of Surgery, Meharry School of Medicine, Meharry Medical College, Nashville, TN, USA.
Background:
Minimally invasive surgery (MIS) has been associated with improved clinical outcomes compared to open surgery for various procedures. However, disparities in access to MIS persist across race/ethnicity, sex, geography, and payor status. This scoping review aims to synthesize existing evidence on disparities in MIS use and outcomes and to highlight key gaps in the literature.
Methods:
A comprehensive literature search was conducted in PubMed and Scopus from 1 January 2020, to 18 October 2024, for US peer-reviewed research on access to and outcomes of MIS in equity-seeking groups. Title/abstracts and full text were independently reviewed, with conflicts resolved by consensus. Information on study characteristics and both clinical and non-clinical outcomes were extracted. Factors associated with adverse clinical outcomes or a lower likelihood of access to MIS were grouped as themes and represented by surgical specialty using a bubble plot. A protocol for this review was pre-registered on Open Science Framework and updated through the course of the study.
Results:
A total of 88 articles involving 11,647,821 patients were included in the review. The most frequently reported domain of disparity was race/ethnicity (n = 62 papers), and the most frequently analyzed specialty was general surgery (n = 41 papers). Overall, a decrease in likelihood of MIS was reported among patients who were Black, Hispanic or Native American, uninsured or on Medicaid, from lower socioeconomic status (SES), and those in rural locations. Adverse clinical outcomes of MIS, such as readmissions and complications, were associated with patients who were Black, female, of lower SES, and on Medicaid. Key gaps in the literature were noted in the investigation of disparities across geography (rurality/urbanicity), language and at the intersection of multiple domains of disparity.
Conclusion:
Our review provides important considerations for understanding the inequities across patient groups in access to and outcomes of MIS.
Insights
Minimally invasive surgery (MIS) offers better outcomes but access and results vary by race, sex, and insurance. This review highlights significant disparities in MIS use and outcomes, calling for further research into these inequities.
Area of Science:
- Surgical Innovation and Health Equity
- Comparative Effectiveness Research
- Health Services Research
Background:
- Minimally invasive surgery (MIS) generally yields superior clinical outcomes compared to traditional open surgery.
- Persistent disparities in MIS access and utilization exist across racial/ethnic, sex, geographic, and socioeconomic lines.
- Understanding these inequities is crucial for advancing equitable surgical care.
Purpose of the Study:
- To conduct a scoping review synthesizing evidence on disparities in MIS access and outcomes.
- To identify key gaps in the current literature regarding MIS equity.
- To inform strategies for reducing disparities in surgical care.
Main Methods:
- Comprehensive literature search of PubMed and Scopus (2020-2024) for US-based research.
- Independent review of titles, abstracts, and full texts, with consensus for conflict resolution.
- Thematic analysis of extracted data on study characteristics, clinical, and non-clinical outcomes.
Main Results:
- 88 articles and over 11 million patients analyzed, with race/ethnicity being the most studied disparity.
- Lower likelihood of MIS access observed in Black, Hispanic, Native American, uninsured, Medicaid, lower SES, and rural populations.
- Adverse MIS outcomes (e.g., readmissions, complications) linked to Black, female, lower SES, and Medicaid patients.
- Significant gaps identified in research on geographic, language, and intersectional disparities.
Conclusions:
- The review underscores critical inequities in patient access to and outcomes from minimally invasive surgery.
- Findings necessitate targeted interventions to address disparities in MIS across diverse patient groups.
- Further research is needed to fully elucidate and mitigate these health inequities.