How to Write a Surgical Case Report (SCARE Guideline)

A surgical case report is judged on the operation itself: what was done, by whom, where, with which devices, and what happened to the patient afterwards.

Guide · 11 min read · Directive Publications Editorial Team

What SCARE adds to a case report

A surgical case report describes one patient whose diagnosis, operation or outcome teaches other surgeons something useful. Reviewers read it differently from a medical case report. They want to know exactly what was done in theatre, who did it, in what kind of hospital, with which devices, and what happened afterwards, because those details decide whether the result can be repeated anywhere else.

The reporting standard for this is the SCARE (Surgical CAse REport) guideline. The original SCARE statement was published in the International Journal of Surgery in 2016. Its authors used the CARE statement for case reports as the starting point for a Delphi consensus, because CARE is not surgically focused. SCARE was updated in 2018, 2020 and 2023, and the current version is the SCARE 2025 guideline, published in Premier Journal of Science. It has 48 items across 19 topics, up from 42 items in 2023, and the six new items cover the use of artificial intelligence.

If you have not written a case report before, start with our guide to the CARE checklist, which covers choosing a case with a real lesson and building the general structure. This post concentrates on what surgery adds. For more than one patient, SCARE is the wrong tool: the same group publishes PROCESS (Preferred Reporting of Case Series in Surgery) for surgical case series.

SCARE 2025 also asks you to say, at the end of the introduction, that the case report has been reported in line with the SCARE checklist, and to cite the 2025 paper. Work from the checklist in the 2025 paper's appendix. It has a page-number column, so you can record where each item appears if the journal asks for a completed checklist at submission.

Step 1: Settle consent for the procedure and publication

Surgical cases create consent problems that a medical case does not. Operative photographs, intra-operative video, scars, stomas, tattoos and imaging of an unusual anatomy can all identify a patient, even with the face and name removed.

SCARE 2025 item 17 says consent should cover both the original intervention or procedure and publication of the case report. It asks you to state the method of consent at the end of the article (for example verbal, written or digital), and if the patient could not consent, to explain why, such as consent given by next of kin after the patient's death. If the patient or family could not be traced, document the tracing efforts.

In practice, many journals expect written consent on their own form, so check before you write. Make sure the form covers each image and any video link you plan to include. Our guide to patient consent for publication covers identifiability, proxies and deceased patients in detail. Settle this first: a case without usable consent is not worth drafting.

Step 2: Build the surgical timeline

SCARE item 8 asks for the sequence of events leading up to presentation and, specifically, any delays from presentation to diagnosis or to intervention. In surgery those delays are often the lesson. A missed diagnosis, a long wait for imaging or a transfer between hospitals changes how the outcome should be read.

Draft the timeline as a table before you write any narrative:

SCARE asks for standardised units of time and dates. Exact calendar dates can help identify a patient, so check whether your consent and the journal's policy allow them; many authors describe events relative to presentation or to the operation instead.

Step 3: Report the work-up and staging

The diagnostic section needs more than a list of results. SCARE item 11 groups it into four parts.

• Diagnostic assessment. Bedside tests, laboratory tests including histopathology, imaging (for example ultrasound, X-ray, CT, MRI or PET) and invasive tests such as endoscopy or biopsy.
• Diagnostic challenges. Anything that made diagnosis difficult, such as access, cost or cultural factors, and how it was overcome.
• Diagnostic reasoning. The differential diagnoses, when they were considered, and why and how each was excluded.
• Prognostic characteristics. Staging where it applies, for example tumour staging, and how it was performed.

For imaging, say what each study showed and why it was ordered. Reviewers notice when an operative decision rests on a scan that the text never describes. If the final diagnosis came from the resected specimen, say so plainly, and report the histopathology in enough detail to support it.

SCARE item 9 also covers the patient's background: de-identified demographics, the presenting complaint, how and where the patient presented, past medical and surgical history, medications including any contraindications to restarting them, allergies, family and social history, and a review of systems. Include what bears on the operation, such as anticoagulants, previous abdominal surgery or functional independence.

Step 4: Describe the operation and the operator

This is the section that makes a surgical case report surgical, and it is where most drafts are thinnest. SCARE item 12 has five parts.

Pre-operative optimisation (12a). Lifestyle measures such as weight loss, medical optimisation such as a medication review, procedural preparation such as nil by mouth or an enema, and other support such as psychological care.

The intervention (12b). The type of intervention, concurrent treatments such as antibiotics, analgesia and venous thromboembolism prophylaxis, and every medical device by manufacturer and model.

Operative detail (12c). The rationale for the treatment, how it was performed and the time to intervention. For surgery, SCARE lists anaesthesia, patient position, skin preparation, relevant equipment, sutures, devices and surgical stage, plus post-operative instructions such as when to remove a drain or staples. State how novel the technique or device is, for example whether it was a first-in-human use.

Operator and setting (12d). Where applicable, give the operator's experience, position on the learning curve, prior relevant training and specialisation. Give the setting, such as a district general hospital or a major trauma centre, the centre's level of experience with the procedure, and whether it was performed with another specialty, as in a hybrid procedure.

Deviations (12e). Any change from the planned intervention and the reason for it. SCARE's own example is a laparoscopic procedure converted to open because of operative difficulty.

Write this section so that a surgeon in another hospital could judge whether to try the same approach. A result achieved by a high-volume team in a specialist centre teaches something different from the same result in a smaller unit.

Step 5: Grade complications and report follow-up

SCARE item 13 asks for follow-up detail under four headings: when (including the maximum follow-up at submission), where, with whom, and how, plus any long-term surveillance, such as imaging after endovascular aneurysm repair. It also asks how well the patient adhered to and tolerated post-operative advice, how that was measured, and a comparison of the expected and attained outcome, with literature to support the expected one. Use patient-reported measures where appropriate, and say when each outcome was recorded.

For complications, SCARE recommends that all complications and adverse or unanticipated events be described in detail and ideally graded with the Clavien-Dindo classification. That system, published by Dindo, Demartines and Clavien in Annals of Surgery in 2004, grades a complication by the treatment needed to manage it, which makes grades comparable between reports. SCARE also asks you to report:

• the precautions taken to prevent complications, such as antibiotic or thromboprophylaxis
• whether a complication was reported to a national agency or manufacturer, if relevant
• the time from the end of the intervention to discharge, and whether it was within the expected range
• 30-day and longer-term morbidity and mortality, where applicable
• whether complications were discussed at a local team or morbidity and mortality meeting
• that there were no complications, if that is the case

Do not leave complications out of a case built around a good outcome. A reviewer who suspects selective reporting will doubt the rest of the paper.

Step 6: Write a discussion with honest limitations

The SCARE discussion items are close to those in CARE: summarise the key findings and the reasoning behind your conclusions, discuss the relevant literature and similar published cases, describe the implications for practice and guidelines, and set out the take-away lessons. SCARE adds a request to say what you would do differently in future cases.

The surgical twist is in strengths and limitations (item 15). Note any multidisciplinary relevance. For a novel technique or device, outline contraindications, alternatives, potential risks and the complications that might appear if it were used in a larger population. One successful operation does not establish that a technique is safe, and the discussion should not imply that it does.

Where appropriate, item 16 invites the patient's own perspective, for example quotes from a consented and anonymised interview.

Step 7: Finish images, declarations and front matter

Clinical images and video (item 19). Where relevant, include images from before, during and after the intervention: radiological, histopathological, clinical photographs and intra-operative images. Annotate them, caption every file, and point out what the reader should see. SCARE allows a link to a narrated operative video. Check the journal's rules on hosting video, and confirm the consent form covers it.

Artificial intelligence (item 5). SCARE 2025 asks you to declare whether AI was used in the research or manuscript development. If it was, items 5a to 5f ask for the purpose, the tool and version, the data provided to it and confirmation that it was de-identified, the authors who checked its output, steps on bias and ethics, and the prompts where possible. The guideline notes that some journals prefer this in the methods or acknowledgements, and that it should also be declared in the cover letter. Our guide to disclosing AI use explains journal policies more broadly.

Additional information (item 18). Author contributions, acknowledgements, conflicts of interest, funding and, where required, ethics committee approval. Disclose whether the case was presented at a conference or regional meeting, and whether it is under consideration at another journal.

Front matter, written last. SCARE asks for "case report" in the title, three to six keywords including "case report", three to five highlights, and a structured abstract under four headings: introduction and importance, presentation of case, clinical discussion, and conclusion, with at least three take-away lessons. These headings differ from some journals' own abstract formats, so follow the journal where the two conflict.

Choosing a journal for a surgical case

Journal fit matters as much as reporting quality. Surgical specialty journals, general surgery journals and dedicated case report journals differ in whether they accept case reports at all, their length and figure limits, whether they ask for a completed SCARE or CARE checklist, and how they host video. Read the instructions for authors before drafting, not after. Our guide to choosing where to publish a case report covers shortlisting and checking indexing.

Before you submit

1. Consent covers the procedure and publication, including every image and video
2. Timeline states delays from presentation to diagnosis and to intervention
3. Imaging, histopathology and staging are reported with how they were done
4. Devices named by manufacturer and model
5. Operator experience, setting and centre experience stated
6. Any conversion or change of plan explained
7. Complications graded with Clavien-Dindo, or "no complications" stated
8. SCARE 2025 cited at the end of the introduction
9. AI use declared, or the AI items marked not applicable
10. Images annotated and captioned

When the report is ready, check the Directive Publications author guidelines for article types and requirements, then submit your manuscript.