Geospatial analysis in addressing surgical care inequities: A scoping review and methodological guide

Surgical system decision-makers are confronted with the challenge of justifying investment in new surgical facilities against expanding the capacity of existing ones, and if worthwhile, where to place such new facilities. Geospatial analysis can provide findings to inform this decision. This scoping review examines how geospatial analysis has been used to identify geographically defined populations experiencing an inequitable access to surgical care to inform the care structures and processes. A comprehensive literature search was performed in November 2024 using the MEDLINE, EMBASE, Scopus, and PubMed databases for English-language peer-reviewed journal articles that carried out geospatial analysis of surgical care and identified geographic locations in need of resource allocations. Two reviewers independently screened studies for inclusion and extracted the data. Studies were summarized based on their findings and analytical methods. Of the nineteen studies included, three types of findings were presented: 1) two studies determined optimal locations for a new surgical facility; 2) six studies recommended strengthening the capacity of existing facilities after ruling out the need to build new ones, and 3) eleven studies identified locations that should be prioritized for resource allocation (e.g., more surgeons) without examining the need for new facilities or the possibility of strengthening existing ones. Gaps in the literature were identified to include a lack of explicit justification and identification of optimal sites for ambulatory surgical centers, use of dated registry data and potentially unreliable self-report data, and a lack of using the most appropriate geospatial techniques to answer surgical care planning questions according to the local context. Practical recommendations on geospatial analysis in surgical research are provided.