Socially Responsible Surgery: Building Recognition and Coalition

Abstract

ImportanceSocially responsible surgery (SRS) integrates surgery and public health, providing a framework for research, advocacy, education, and clinical practice to address the social barriers of health that decrease surgical access and worsen surgical outcomes in underserved patient populations. These patients face disparities in both health and in health care, which can be effectively addressed by surgeons in collaboration with allied health professionals.ObjectiveWe reviewed the current state of surgical access and outcomes of underserved populations in American rural communities, American urban communities, and in low- and middle-income countries.Evidence reviewWe searched PubMed using standardized search terms and reviewed the reference lists of highly relevant articles. We reviewed the reports of two recent global surgery commissions.ConclusionThere is an opportunity for scholarship in rural surgery, urban surgery, and global surgery to be unified under the concept of SRS. The burden of surgical disease and the challenges to management demonstrate that achieving optimal health outcomes requires more than excellent perioperative care. Surgeons can and should regularly address the social determinants of health experienced by their patients. Formalized research and training opportunities are needed to meet the growing enthusiasm among surgeons and trainees to develop their practice as socially responsible surgeons.

Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery

“…A movement emphasizing socially responsible surgery aims to encourage surgeons and healthcare providers to advocate for surgical access amongst underserved populations. 87 Adequate access to surgical care is especially important given that long-term foster care centers located in urban, underprivileged areas care for a youth population with nearly 40% overweight and 23% obesity. Further, adolescents ages 12-19 remain at higher risk for obesity than children ages 2-5.…”

Back to Basics: Social Determinants of Health

“…Initiatives are emerging to address SDOH in various parts of the United States; some of these involve community efforts outside health care while others address efforts in the health care environment. The term socially responsible surgery (SRS) refers to the “field of study and clinical practice that integrates surgery and public health” (p1) and addresses the SDOH of perioperative patients in all types of surgical environments (ie, rural, urban, global). Surgeons and students in the Department of Surgery at Boston Medical Center and the Boston University School of Medicine, Massachusetts, have created a successful SRS initiative that includes a…”

“… team of mental health professionals who work with and advocate for victims of violence, preventive food pantry that supplies food at no charge to families that are food insecure, medical facility that provides around‐the‐clock medical support for homeless patients, and medical‐legal partnership to provide legal services to families in need …”

“…• medical-legal partnership to provide legal services to families in need. 5 The hospital's trauma surgeons are consultants for some of the SRS initiatives and help provide resources and appropriate strategies for preventing future interpersonal violence for team members to impart to patients; the surgeons also provide education about injury prevention and how to help break the cycle of violence for surgical program students so they can better assist their patients. Although the surgeons at this facility have achieved some success in implementing strategies to improve SRS, the initiative needs to spread across multiple settings and locations to improve the surgical care of those patients affected by SDOH.…”

Translational research: turning research into advocacy

“…Given that nearly one-third of US counties have no practicing surgeon, we need our young trainees to choose surgery 2. Surgeons need to show these upcoming students and residents that there is mentorship regarding the social determinants of health in relation to our surgical patients.…”