Abstract
BACKGROUND: Emergency surgical care is a critical yet often unavailable component of health systems in many low-resource and crisis-affected settings. Due to chronic shortages of trained surgeons, task-shifting models involving nurses and other non-physician providers, such as clinical or assistant medical officers, have been explored to deliver essential surgical interventions. This systematic review and proportional meta-analysis evaluated the procedural success, safety profile, and clinical outcomes of emergency surgeries performed by nurse-surgeons and other non-physician providers across diverse settings and surgical domains. METHODS: A PROSPERO registered (CRD42023464699) systematic review and proportional meta-analysis was conducted, including non-randomized studies that reported outcomes of nurses and other non-physician providers. Databases were searched from March - April 2025 using predefined Boolean and MeSH-based strategies, and studies were screened based on eligibility criteria guided by a PECOS framework. Primary outcomes were procedural success rates and adverse events (complications or mortality). A GRADE assessment and sensitivity analyses were also performed to assess the certainty and robustness of the findings. RESULTS: Across included studies, procedural success ranged from 93.3% to 99.5%. Because procedures and denominators were clinically non-comparable, a single pooled estimate was not calculated. In clinically coherent groups, pooled maternal survival following emergency obstetric procedures was 99% (n/N = 1272/1284; 95% CI 97.9–99.6; I²= 38.2%, τ² = 0.1074), and pooled cricothyrotomy procedural success was 95.1% (n/N = 81/85; 95% CI 90.7–97.6; I² = 0.0%, τ²= 0.0000). Minor complications occurred in ≤ 2% of procedures across individual studies, and severe adverse events did not exceed 2% in any study. Analysis further revealed that consistency of outcome appeared similar across settings (rural, conflict, tertiary), anaesthetic techniques (ketamine, spinal, local), and nurse training protocols (short intensive courses vs. formal curricula), although formal subgroup comparisons were not performed due to the limited number of studies. Immediate on-site procedures and standardized equipment sets were most cited as facilitators of successful outcomes, and the only significant exception related to technical difficulties in high-acuity trauma cannulation. CONCLUSIONS: From a procedural standpoint, task-shifted emergency surgeries performed by nurse-surgeons and other non-physician providers demonstrated high procedural success with low complication rates across a range of clinical settings. These findings support the short-term safety and feasibility of task-shifted emergency surgery when implemented with appropriate training and mentorship, particularly in low-resource settings. REGISTRATION: The protocol for the review was registered at PROSPERO (CRD42023464699). CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-026-04603-1.