M.J. Mauney1, N. Kogut1, S. Beerman1, H. Dean1, S. Snider1, J. Checketts2 1New York College Of Osteopathic Medicine, Jonesboro, AR, USA 2Oklahoma State University Medical Center, Department Of Orthopaedic Surgery, Tulsa, OKLAHOMA, USA
Introduction: Clinical practice guidelines (CPGs) are considered powerful and efficient means for promoting evidence-based medicine. Inappropriate application of race/ethnicity terms may result in negative outcomes in historically marginalized populations. Therefore, the use of these terms in CPGs warrants investigation. This systematic review evaluated the use of race/ethnicity terms in general surgery CPGs while utilizing Critical Race Theory (CRT) as a framework to assess their effects on patient outcomes.
Methods: The following databases were searched for general surgery CPGs: PubMed, Medscape, and ECRI. Additionally, relevant societies and organizations were also searched. CPGs published between January 1, 2019 and April 30, 2024, written in English, and intended for adult patients in the United States were included. In a blinded, duplicate fashion, two authors screened, extracted, and categorized race/ethnicity terms based on their potential positive, negative, or indeterminate effect on health inequities.
Results: Our initial search yielded 2,097 articles. After screening and exclusion, 255 CPGs remained for evaluation. Race/ethnicity terms were used in 393 statements across background, clinical recommendations, or future directions CPG sections. Potentially negative effects on health inequities were found in 142 statements (36.1%), and potentially positive effects on health inequities were found in 194 statements (49.4%). Sixty-seven statements (17%) had an indeterminate effect and 10 had potentially positive and negative effects.
Conclusion: CPGs that inappropriately use race/ethnicity terms may worsen patient outcomes. Using CRT, we assessed and categorized these statements in general surgery CPGs to analyze their effects. Our study found that over one-third of the race/ethnicity statements in CPGs may exacerbate health inequities. Therefore, we believe journals that publish CPGs should require authors to undergo training under the guidance of CRT as well as seek instruction in genetic anthropology. Additionally, we recommend establishment of a separate sector of medical literature review for use of race/ethnicity terms. Finally, we believe authors should emphasize the need for future research addressing health inequities and disparities. The goal of our recommendations is to potentially improve patient outcomes for historically marginalized groups.