Surgical Care of Patients Experiencing Homelessness: A Scoping Review Using a Phases of Care Conceptual Framework

Abstract

What is the current state of literature regarding the surgical care of homeless patients? Findings: In this systematic scoping review of 23 studies, a Phases of Care framework was developed to organize evidence unique to the surgical care of homeless patients, a vulnerable and growing population. Selected studies were heterogeneous and limited, particularly regarding the impact of housing status on surgical or anesthetic approach. Definitions of homelessness varied or were absent across studies.Meaning: Research on optimal surgical care for the homeless is sparse. A key next step is recording housing status in surgical databases using a standardized definition.

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

“…Homeless patients face unique challenges throughout the surgical care continuum. 16 , 17 The few studies that have explored surgery in the homeless population highlight higher rates of postoperative emergency department usage and hospital readmission, 14 , 18 , 19 increased length of stay and costs of admission, 20 , 21 and lower rates of follow-up. 14 However, the impact of homelessness on surgical outcomes, including for patients with orthopedic trauma, remains largely understudied.…”

A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities

“…A forward snowballing strategy was also used to identify relevant literature from other published studies on this topic. 22 The inclusion criteria were studies published in English that described a direct connection between surgical care and PEH. Studies that referred to dentistry, emergency/disaster response and refugees were excluded.…”

“…The surgical needs of PEH are not well documented, yet housing status affects the approach to surgical care along its entire continuum from preoperative preparation to surgical decision-making and postoperative care. 22 …”

Delivering the Right Care, at the Right Time, in the Right Place, From the Right Pocket

“…When patients are without a safe and stable place to live, they tend to present for care with more complicated illness and fewer resources to adhere to treatment plans (especially in cases involving chronic homelessness) 3–5 . Challenges from homelessness can lead to longer hospital stays, 6 more medical complications, 7 and greater odds of 30-day readmission when compared to patients with stable housing 4,5 …”