Operating under pressure: a scoping review of the effects of climate change on general surgery

INTRODUCTION: Climate change adversely impacts human health; however, its effect on surgical diseases remains poorly understood. We conducted a scoping review to elucidate the current understanding of climate change's role in general surgical care and care delivery. METHODS: A comprehensive search of Medline, Embase, Cochrane, and CINAHL was supplemented by manual searches. Broad terms for climate change in general surgery and its subspecialties were used. Climate-related effects were defined as daily or seasonal temperature anomalies and extreme weather events (e.g., hurricanes, floods, wildfires). Full-text articles were reviewed for relevance to treatment of surgical diseases, postoperative outcomes, and access to surgical care attributable to climate change. Thematic analysis identified recurring themes among included studies. RESULTS: Of 5110 studies, 28 met inclusion criteria. Three themes were identified: access to surgical care, shifts in surgical disease burden, and postoperative outcomes. Five studies described decreased access to care following extreme weather events, including one reporting increased breast cancer mortality after Hurricane Katrina. Eleven studies highlighted shifts in surgical disease patterns. Temperature anomalies correlated with higher rates of traumatic injuries, skin and soft tissue infections, and complicated appendicitis. Extreme weather events were associated with increased surgical trauma and emergency case volume. Five articles found temperature anomalies associated with higher postoperative surgical site infection rates, while two did not. Four articles examined outcomes after extreme weather events, including one associating wildfire smoke exposure with worse overall survival after lung resection and another identifying longer hospital stays in wildfire-exposed facilities. CONCLUSION: High-level evidence regarding climate change's impact on general surgery remains limited. Emerging evidence suggests that extreme weather events and temperature fluctuations may increase demand for surgical services, disrupt timely access to treatment, and worsen postoperative outcomes. These effects may further strain healthcare systems and resources, requiring targeted mitigation and future research in this important evolving field.