Geographic barriers to children's surgical care: A systematic review of existing evidence

Radek Buss, Gopika SenthilKumar, Megan Bouchard, Alexis Bowder, John Marquart, Jo Cooke-Barber, Emily Vore, Daniel Beals, Mehul Raval, Barrie S. Rich, Seth Daniel Goldstein, Kyle Van Arendonk*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Background: Ensuring that children have access to timely and appropriate surgical care is a vital component of comprehensive pediatric care. This study systematically reviews the existing evidence related to geographic barriers in children's surgery. Methods: Medline and Scopus databases were searched for any English language studies that examined associations between geographic burden (rural residence or distance to care) and a quantifiable outcome within pediatric surgical subspecialties. Two independent reviewers extracted data from each study. Results: From 6331 studies screened, 22 studies met inclusion criteria. Most studies were retrospective analyses and conducted in the U.S. or Canada (14 and three studies, respectively); five were conducted outside North America. In transplant surgery (seven studies), greater distance from a transplant center was associated with higher waitlist mortality prior to kidney and liver transplantation, although graft outcomes were generally similar. In congenital cardiac surgery (five studies), greater travel was associated with higher neonatal mortality and older age at surgery but not with post-operative outcomes. In general surgery (eight studies), rural residence was associated with increased rates of perforated appendicitis, higher frequency of negative appendectomy, and increased length of stay after appendectomy. In orthopedic surgery (one study), rurality was associated with decreased post-operative satisfaction. No evidence for disparate outcomes based upon distance or rurality was identified in neurosurgery (one study). Conclusions: Substantial evidence suggests that geographic barriers impact the receipt of surgical care among children, particularly with regard to transplantation, congenital cardiac surgery, and appendicitis.

Original languageEnglish (US)
JournalJournal of pediatric surgery
StateAccepted/In press - 2021


  • Distance to care
  • Geographic barriers
  • Healthcare access
  • Pediatric surgery access

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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