Diversity and Expertise Among Authors of U.S. Surgical Society Clinical Guidelines

Abstract

Background

Clinical practice guidelines (CPGs) shape surgical care and outcomes, but concerns persist regarding the diversity and expertise of their authors. Whether U.S. surgical society guidelines reflect inclusive and expert-driven authorship remains unknown.

Methods

We conducted a cross-sectional analysis of 213 CPGs published by 11 national U.S. surgical societies between 2015 and 2024. We assessed author gender, race/ethnicity, and prior publication history using validated name-based algorithms and PubMed queries. Authors were classified as underrepresented in medicine (URiM) if identified as Black and Hispanic/Latino. Trends over time were analyzed using the Jonckheere-Terpstra test.

Results

Among 2185 authors, 557 (25.5%) were women and 111 (5.1%) were URiM. Over half of guidelines (52.1%) had no URiM authors, and 21.6% had no female authors. Female representation increased over time (P = 0.02), while URiM representation remained unchanged (P = 0.32). Representation varied widely across societies. Among first and corresponding authors, 45% had fewer than 5 topic-specific publications. Additionally, 486 (14.7%) of all authors had no prior guideline authorship experience.

Discussion

CPGs published by U.S. surgical societies from 2015 to 2024 demonstrated persistent gaps in gender and racial/ethnic diversity, as well as inconsistent subject-matter expertise among authors. These findings raise concerns about the representativeness and rigor of current guideline development practices. Surgical societies should consider reforms to authorship selection processes to promote more inclusive and expert-driven guidance reflective of the populations they serve.