Surgical Emergencies in Space: Management and Protocol Development for Artemis and Martian Missions

As human spaceflight expands to Lunar and Martian missions, medical care must evolve from evacuation-based support to autonomous, in-mission capability. Surgical emergencies pose high-risk threats to crew health (LOC) and mission (LOM). While non-operative management (NOM) has shown success on Earth, its reliability in space is limited. High recurrence/crossover rates from Earth-based trials (appendicitis) are also of particular concern.

NASA’s medical models (IMM, IMPACT) identify 20 reversible surgical conditions likely to occur during long-duration missions, with appendicitis and non-fatal trauma serving as the prototypical use cases. This review synthesizes data from 140 peer-reviewed studies across aerospace medicine, surgery, immunology, systems engineering and biochemistry to propose a space-adapted surgical framework.