Global challenges and perspectives in acute and emergency general surgery in low and middle-income countries: a scoping review
Mahmoud Diaa Hindawi, Arda Isik, Fausto Rosa, Diego Visconti, Taras Nechay, Sharfuddin Chowdhury, Abdourahmane Ndong, Tushar S Mishra, Stefano Piero Bernardo Cioffi, Abd-Elfattah Kalmoush, Francesco Piscioneri, Walter L Biffl, Edward C T H TanBackground
Acute and emergency general surgery in low and middle-income countries (LMICs) faces critical disparities. Despite global and regional initiatives, surgical inequities persist due to fragile healthcare infrastructure, workforce shortages and insufficient policy integration. This study explores the systemic challenges and perspectives in acute and emergency surgical care in LMICs while evaluating global efforts to bridge these gaps.
Methods
We searched seven databases from inception to 26 November 2024, with an updated search through 12 June 2025. Records were screened in duplicate according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance, and included studies were charted across major health-system domains, including workforce/training, infrastructure, prehospital and emergency response systems, financing, governance/policy and regional capacity-building initiatives.
Results
A total of 160 studies were included. The evidence was geographically diverse and was mapped across overlapping thematic domains rather than assigned to single mutually exclusive categories because many studies addressed more than one health-system component. The main recurrent domains were workforce shortages and training gaps, infrastructure andIntensive Care Unit limitations, fragmented prehospital and emergency response systems, financial barriers, weak policy enforcement and emerging capacity-building strategies. Across these domains, access to timely, safe and affordable acute and emergency surgical care remained limited, particularly in rural and underserved LMIC settings.
Conclusion
While international efforts have made progress, more attention is needed on locally driven solutions, structured training and broader healthcare system investment. The next step is conducting multicentre surveys to identify key challenges and create evidence-based protocols. Future research should focus on context-specific solutions, innovative funding and scalable strategies to strengthen surgical care. This study is a first step in identifying challenges for future policies aimed at ensuring universal access to safe, timely surgical care in LMICs.