The use of Mobile Surgical Units in austere environments and rural areas: a systematic review

Abstract

Background: Mobile surgical units (MSU) have been used since World War II to facilitate surgical care at the frontlines. However, their role in modern-day surgical practice, particularly in austere environments and low-to-middle-income countries (LMIC), is not clear. This study aimed to perform a systematic review of the current literature and illustrate different types of MSUs and their uses, benefits, and limitations.

Methods: A PRISMA-compliant systematic review was conducted using PubMed, OVID Medline, CENTRAL, Embase, Scopus, and Web of Science from inception to April 2023. Studies evaluating MSU use in LMICs or austere environments were included. Two reviewers independently screened titles, abstracts, and full-text articles, with consensus achieved by a third reviewer. Data extraction and level of evidence assessment were performed using the Oxford Centre for Evidence-Based Medicine classification.

Results: Of 460 studies identified, 24 were included in the analysis. The most common MSU model was truck/bus-based (n=15, 62.5%), followed by portable models including the "SurgiBoxTM" sterile operative field. General surgery was the most common specialty (n=10, 41.7%), followed by obstetrics and gynecology (n=7, 29.2%). Main benefits included improved patient access, reduced wait times, and lower costs compared to conventional operating rooms. Limitations included crowding with increased surgical site infection risk (up to 14.3% in one study) and sustainability concerns. Study quality was poor, with 58.3% being case series (Level 4 evidence).

Conclusions: MSUs represent promising alternatives for providing surgical care in LMICs and austere environments. However, further research and improvement of MSU designs are required to enhance safety and reduce perioperative complications.