Cost-saving strategies for sustainable surgical care: a scoping review of efficiency models and potential approaches for low-income and middle-income countries

Most literature on cost savings for surgical healthcare was from high-income countries (81%), at national levels (48%), and focused on orthopaedic/cardiothoracic/vascular surgery. Most (25%) were retrospective observational studies or economic modelling (21%). We synthesised 125 distinct cost-saving strategies into 32 transferable strategies across five thematic areas, prioritised using a sustainability and scalability lens-preventative healthcare management (9%), surgical healthcare guidelines and pathways (31%), payment model transformation (19%), lean principles (25%) and technology adoption (16%). Strategies focused on governance, standardisation and process redesign were more likely to be sustainable and scalable with minimal resources, whereas interventions requiring coordinated delivery models or advanced digital infrastructure were more scale-dependent CONCLUSIONS: We identified an integrated portfolio of contextualisable surgical cost-saving strategies that eliminate system waste, improve efficiency and result in savings. Policymakers and health system stakeholders in low-income and middle-income countries can use this structured evidence to prioritise, implement and scale cost-saving strategies.