Who sees us? A scoping review on the surgical needs among patients experiencing homelessness

Housing insecurity impacts over 500,000 individuals in the United States annually, presenting significant barriers to healthcare access. However, there remains a limited understanding of the challenges surrounding surgical care for patients experiencing homelessness (PEH). A scoping review was conducted to address gaps in the literature on the documentation of housing status in surgical care for PEH. Several databases were comprehensively searched for keywords and index terms related to housing status and surgery from 2002 to 2021. Abstract screening and full-text review was performed following the PRISMA-ScR and Joanna Briggs Institute's guidelines for scoping reviews. Data analysis was performed using a health equity framework. Among the 63 included entries, 15 articles provided explicit definitions of homelessness or housing status. Among the case studies, 7 addressed the influence of housing on clinical decision-making, while 22 did not. Cardiothoracic surgeries were the most highly represented sector (n = 10). The financial burden was discussed in five articles. The association between housing insecurity and morbidity and mortality endpoints was investigated in 27 entries. Housing status is poorly defined and documented for PEH, leading to challenges in access to care and an overall higher burden on the healthcare system.