Assessment of LGBTQ+ Diversity, Equity, and Inclusion in Subspecialty Surgery Literature: A Scoping Review

Abstract

Objective: To identify LGBTQ+ diversity, equity, and inclusion (DEI) publications and contextualize the current frequency of the literature across subspecialty surgical fields.

Methods: A PRISMA systematic review using PubMed, MEDLINE, and Web of Science was conducted in April 2024. The main inclusion criterion was intrafield DEI content for defined subspecialties; exclusion criteria were foreign language, poor methodology, and duplicates. The primary endpoint was the number of publications across subspecialties. Secondary endpoints included publication dates, study design, and sample size.

Results: Of the 702 articles identified, 27 were included in the analysis. Neurologic surgery had 2 studies; plastic surgery, 11 studies; orthopedic surgery, 7 studies; otolaryngology, 5 studies; and thoracic surgery, 2 studies. There was a statistically significant different frequency of publications across subspecialties (P = 0.031). Post hoc residual analysis indicated that neurosurgery and thoracic surgery had statistically fewer publications, while plastic surgery had statistically more publications (P = 0.04, 0.002, 0.21, 0.42, and 0.04 for neurologic surgery, plastic surgery, orthopedic surgery, otolaryngology, and thoracic surgery, respectively). Secondary outcomes found a majority of publications between 2022 and 2024. Study methodologies involved cross-sectional studies, editorials, and retrospective reviews (14, 11, and 3 respectively) and had a median sample size of 248.5.

Conclusions: This systematic review provides objective data to contextualize DEI literature across surgical subspecialties. Overall, this review highlights the lack of LGBTQ+ DEI literature in neurosurgery and advocates for correcting this gap for the benefit of both surgeons and patients. Understanding the current numbers and evaluating progress in other surgical fields might provide solutions.

Keywords: Diversity, equity, and inclusion; LGBTQ+; Scoping review; Sexual and gender minority.