Annals Of Surgery Research Articles

Factors Associated With the Highest and Lowest Cited Research Articles in General Surgery Journals

BackgroundCitation count is a common bibliometric tool used to determine the long-term impact and performance of journal articles. Many of the other potential factors associated with highly and lowly cited articles in the general surgery literature, however, remain unknown. The purpose of this study was to attempt to identify characteristics of articles that may predict or correlate with article citation counts and, consequently, article impact. MethodsWe identified articles from Annals of Surgery, British Journal of Surgery, and Journal of the American College of Surgeons between 1998 and 2008 that had 0-5 total citations. We then matched these articles to an identical number of the highest cited articles from these same journals for comparison. Student's t-tests, Wilcoxon rank-sum tests, chi-squared tests, and Fisher's exact tests were used to determine the significance of difference between data sets at a predetermined level of significance set to P < 0.05. ResultsSignificant differences of article characteristics between the two cohorts included higher prevalence of clinical studies (P = 0.3919), multi-institutional (P = 0.0007) and multi-national (P = 0.0023) studies, surgical oncology (P < 0.0001) or hepatobiliary focus (P < 0.0001) and published in Annals of Surgery (P < 0.0001) for the highly cited cohort. Highly cited articles were also more likely to have larger sample sizes (P = 0.0009), more authors (P < 0.0001), presence of statistically significant results (P < 0.0001), more references (P < 0.0001), more tables (P < 0.0001), more figures (P = 0.0001), and higher word counts for manuscript (P < 0.0001), abstract (P < 0.0001), and title (P < 0.0001). ConclusionsThere are a relatively small number of articles with 0-5 citations after 10 y for these major general surgery journals. This indicates that journals are consistently able to select articles that will be impactful in aiding future research. Certain factors, however, are associated with being highly cited as opposed to lowly cited, and an understanding of these factors can aid researchers and journals in designing and reporting future studies.

Spotlight in Plastic Surgery: April 2020

Spotlight in Plastic Surgery: April 2020

Spotlight in Plastic Surgery: January 2020

Spotlight in Plastic Surgery: January 2020

Visual Abstracts in Medical Journals

Social media, especially Twitter, crept into academic fields and have become a vital part of all the medical fields and journals.1 Medical journals have been increasingly using Twitter to disseminate their contents to attract a wider readership. The Transplantation Journal, that started tweeting from 2015 to “improve engagement with readership and connect with the authors”, showed that the papers that were tweeted were three times more likely to be downloaded than the non-tweeted ones (p&lt;0.001).Some of the journals started new initiatives to improve their interactions with readers in social media like podcasts, video abstracts and reviews, and Visual Abstracts (VA). VA is a form of graphical abstract used by medical journals. VA was introduced in Annals of Surgery in July 2016.4 Other forms of graphical abstracts in the field of chemistry had appeared as early as 1976. VA is a visual summary of a research manuscript. It consists of a single-page poster that is simple, eye-catching and summarizes the background, methodology, results, and conclusion of the study. These are published or tweeted for improved dissemination of the paper, for deeper engagement of scientists, and to influence busy readers.

Spotlight in Plastic Surgery: October 2019

Spotlight in Plastic Surgery: October 2019

WERNICKE ENCEPHALOPATHY AFTER GASTRIC BYPASS: A SURPRISING ETIOLOGY OF ALTERED MENTAL STATUS PROGRESSING TO CARDIAC ARREST

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Wernicke’s Encephalopathy (WE) after bariatric surgery is more frequent than commonly understood. Doctors and patients must be aware of the risk and predisposing factors for WE to effectively prevent this potentially fatal condition. In this case, we present a patient with a late diagnosis of WE, with altered mental status resulting in eventual cardiac arrest and intubation. CASE PRESENTATION: A 63-year-old woman was brought to the ED after being found at home confused. She had no history of alcohol use. She exhibited disconjugate gaze and mental slowing, but was otherwise neurologically intact. CT brain demonstrated no acute changes and labs were normal. The patient had a sleeve gastrectomy 2 months prior, and a history of depression and anxiety. Family reported that following bariatric surgery she had poor oral intake and frequent vomiting. She was admitted for confusion and dehydration, and diagnosed with a UTI. She remained altered and on hospital day 9 the patient suffered a cardiac arrest of unclear etiology and CPR was started. She was intubated and transferred to the ICU, where she remained minimally responsive for several days. A brain MRI then demonstrated evidence of WE, specifically T2 FLAIR hyperintense signal abnormalities involving the mammillary bodies, medial thalami, periaqueductal area, and around the third ventricle. Intravenous thiamine was started immediately. Over the next few days, her mental status slowly began to recover. DISCUSSION: WE is primarily associated with malnutrition and chronic alcohol use, however hyperemesis gravidarum or bariatric surgery recovery can also produce the syndrome. Patients who undergo bariatric surgery are at risk of multiple vitamin deficiencies; B1 deficiency is common enough to have garnered the nickname “bariatric beriberi”. The classic triad for WE consists of ataxia, nystagmus, and confusion. The underlying pathophysiology is related to severe thiamine deficiency, and symptoms can be precipitated by glucose loading causing lactic acidosis in the medial thalamus resulting in neuronal damage. In a 2008 review of 84 existing cases, 94% occurred within the first 6 months post-surgery. As with our patient, MRI revealed lesions in 47% of patients. In 2007, another review found WE was most likely to occur between 4 and 12 weeks after surgery; our patient presented with symptoms at 8 weeks post-surgery. A case series from Southern Europe reported a preventive intervention after biliopancreatic diversion; no WE cases were observed after initiating administration of large doses of thiamine to patients reporting small food intakes during early postoperative weeks. CONCLUSIONS: Our patient’s altered mentation seems to have begun after diminishing PO intake for days at home. Given the risk for WE with progression to severe altered mental status, providers should consider thiamine deficiency in altered patients with recent bariatric surgeries. Reference #1: Aasheim ET. Wernicke Encephalopathy After Bariatric Surgery. Annals of Surgery. 2008;248(5):714-720. https://doi.org/10.1097/SLA.0b013e3181884308. Reference #2: Sonal S, Abhay K. Wernicke encephalopathy after obesity surgery Neurology Mar 2007, 68 (11) 807-811; https://doi.org/10.1212/01.wnl.0000256812.29648.86 DISCLOSURES: No relevant relationships by Mitchell Brown, source=Web Response No relevant relationships by Amy Wolfe, source=Web Response

Analysis of Authorship in Hepatopancreaticobiliary Surgery: Women Remain Underrepresented

IntroductionGiven the need to increase female representation in hepatopancreatobiliary (HPB) surgery, as well as the need to increase the academic pipeline of women in this subspecialty, we sought to characterize the prevalence of female authorship in the HPB literature. In particular, the objective of the current study was to determine the proportion of women who published HPB research articles as first, second, or last author over the last decade. MethodsAll articles pertaining to hepatopancreaticobiliary (HPB) surgery appearing in seven surgical journals (Annals of Surgery, British Journal of Surgery, JAMA Surgery, Annals of Surgical Oncology, HPB (Oxford), Surgery, and Journal of Gastrointestinal Surgery) were reviewed for the years 2008 and 2018. Information on sex of author, country of author’s institution, and article type was collected and entered into a computerized database. ResultsAmong the 1473 index articles included in the final analytic cohort, 414 (28%) publications had a woman as the first or last author, while the vast majority (n = 1,059, 72%) had a man as the first or last author. The number of female first authors increased from 15.6% (n = 92/591) in 2008 to 25.7% (n = 227/882) in 2018 (p < 0.001). There were no differences in the proportion of second (n = 123/536, 23.0% vs n = 214/869, 24.6%, p = 0.47) or last (n = 44/564, 7.8% vs n = 88/875, 10.1%, p = 0.15) authors. Women were more likely to publish papers appearing in medium-impact journals (OR 1.40, 95% CI 1.04–1.88) and articles with a female author were more likely to be from a North American institution (referent: North America, Asia OR 0.43, 95% CI 0.31–0.59 vs Europe OR 0.67, 95% CI 0.51–0.87). ConclusionWomen first/last authors in HPB research articles have increased over the past 10 years from 22 to 32%. Women as last authors remain low, however, as only 1 in 10 papers had a senior woman author. These data should prompt HPB leaders to find solutions to the gap in female authorship including mentorship of young female researchers and surgeons.

Is the Power Threshold of 0.8 Applicable to Surgical Science?—Empowering the Underpowered Study

BackgroundMany articles in the surgical literature were faulted for committing type 2 error, or concluding no difference when the study was “underpowered”. However, it is unknown if the current power standard of 0.8 is reasonable in surgical science. MethodsPubMed was searched for abstracts published in Surgery, JAMA Surgery, and Annals of Surgery and from January 1, 2012 to December 31, 2016, with Medical Subject Heading terms of randomized controlled trial (RCT) or observational study (OBS) and limited to humans were included (n = 403). Articles were excluded if all reported findings were statistically significant (n = 193), or if presented data were insufficient to calculate power (n = 141). ResultsA total of 69 manuscripts (59 RCTs and 10 OBSs) were assessed. Overall, the median power was 0.16 (interquartile range [IQR] 0.08-0.32). The median power was 0.16 for RCTs (IQR 0.08-0.32) and 0.14 for OBSs (IQR 0.09-0.22). Only 4 studies (5.8%) reached or exceeded the current 0.8 standard. Two-thirds of our study sample had an a priori power calculation (n = 41). ConclusionsHigh-impact surgical science was routinely unable to reach the arbitrary power standard of 0.8. The academic surgical community should reconsider the power threshold as it applies to surgical investigations. We contend that the blueprint for the redesign should include benchmarking the power of articles on a gradient scale, instead of aiming for an unreasonable threshold.

A bibliometric study on pancreatic cystic disease research

Abstract Pancreatic cystic disease is being increasingly identified in patients, and many relevant papers have been published in this field. A bibliometric analysis was previously performed to identify the most influential studies in many subject areas, and the top 100 most cited papers on pancreatic cystic disease were analyzed in this study. The Web of Science database was searched for all papers related to pancreatic cystic disease on June 9, 2018. The top 100 most cited papers were selected and listed in descending order based on the total number of citations (TCs). The author, journal, institution, country of origin, and research focus were further analyzed. The most cited papers were published between 1975 and 2015. Intraductal papillary mucinous neoplasm was the most commonly studied subtype (36%), followed by pancreatic pseudocyst (16%), solid pseudopapillary neoplasm (9%), and mucinous cystic neoplasm (7%). The average number of TCs was 282, and the average citation index value was 21. Thirty-eight journals published the top 100 papers; Annals of Surgery (n = 14) and Gastrointestinal Endoscopy (n = 11) published the most papers. Most papers were published in the United States of America (59%), with the majority from Johns Hopkins Medical Institution (15%). Canto MI from Johns Hopkins Medical Institution authored the largest number of most cited papers (n = 8). This study reviews the significant achievements and developmental trends in pancreatic cystic disease.

The Top 100: A Review of the Most Cited Articles in Surgery

IntroductionWe performed a study of the top 100 most cited articles in the five general surgery journals with the highest impact according to Journal Citation Report. MethodsWe selected the five journals with the highest impact in 2015: Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons. In January 2017, using the Web of Science application, we performed a search of all articles published by these journals and identified the 100 most cited articles (top 100). We evaluated the number of citations, year of publication, type of article, country and hospital of the article, area of interest and number of authors. ResultsThe median number of citations per top 100 paper was 490. Twenty percent of the top 100 papers have been published since 2000. Overall, 70% are original papers, 8% randomized control trials, 11% reviews, 1% meta-analyses and 11% other subtypes. There are 13% proceedings papers. Sixty-one percent are from the US. The most frequently discussed topic is hepato-pancreato-biliary surgery (33%). ConclusionsThe top 100 most cited articles tend to be original articles describing studies carried out in the US, reporting significant surgical breakthroughs. Hepato-pancreato-biliary surgery is the most common subject area. Annals of Surgery had twice as many citations as the other journals studied. The archetypal article of the Top15 most cited is an original paper published in the twentieth century, with an average of 2000 citations.

3132 Machine Learning for Prediction of Pathologic Pneumatosis Intestinalis Using CT Scans

OBJECTIVES/SPECIFIC AIMS: This retrospective study aims to create and train machine learning models using a radiomic-based feature extraction method for two classification tasks: benign vs. pathologic PI and operation of benefit vs. operation not needed. The long-term goal of our study is to build a computerized model that incorporates both radiomic features and critical non-imaging clinical factors to improve current surgical decision-making when managing PI patients. METHODS/STUDY POPULATION: Searched radiology reports from 2010-2012 via the UPMC MARS Database for reports containing the term “pneumatosis” (subsequently accounting for negations and age restrictions). Our inclusion criteria included: patient age 18 or older, clinical data available at time of CT diagnosis, and PI visualized on manual review of imaging. Cases with intra-abdominal free air were excluded. Collected CT imaging data and an additional 149 clinical data elements per patient for a total of 75 PI cases. Data collection of an additional 225 patients is ongoing. We trained models for two clinically-relevant prediction tasks. The first (referred to as prediction task 1) classifies between benign and pathologic PI. Benign PI is defined as either lack of intraoperative visualization of transmural intestinal necrosis or successful non-operative management until discharge. Pathologic PI is defined as either intraoperative visualization of transmural PI or withdrawal of care and subsequent death during hospitalization. The distribution of data samples for prediction task 1 is 47 benign cases and 38 pathologic cases. The second (referred to as prediction task 2) classifies between whether the patient benefitted from an operation or not. “Operation of benefit” is defined as patients with PI, be it transmural or simply mucosal, who benefited from an operation. “Operation not needed” is defined as patients who were safely discharged without an operation or patients who had an operation, but nothing was found. The distribution of data samples for prediction task 2 is 37 operation not needed cases and 38 operation of benefit cases. An experienced surgical resident from UPMC manually segmented 3D PI ROIs from the CT scans (5 mm Axial cut) for each case. The most concerning ~10-15 cm segment of bowel for necrosis with a 1 cm margin was selected. A total of 7 slices per patient were segmented for consistency. For both prediction task 1 and prediction task 2, we independently completed the following procedure for testing and training: 1.) Extracted radiomic features from the 3D PI ROIs that resulted in 99 total features. 2.) Used LASSO feature selection to determine the subset of the original 99 features that are most significant for performance of the prediction task. 3.) Used leave-one-out cross-validation for testing and training to account for the small dataset size in our preliminary analysis. Implemented and trained several machine learning models (AdaBoost, SVM, and Naive Bayes). 4.) Evaluated the trained models in terms of AUC and Accuracy and determined the ideal model structure based on these performance metrics. RESULTS/ANTICIPATED RESULTS: Prediction Task 1: The top-performing model for this task was an SVM model trained using 19 features. This model had an AUC of 0.79 and an accuracy of 75%. Prediction Task 2: The top-performing model for this task was an SVM model trained using 28 features. This model had an AUC of 0.74 and an accuracy of 64%. DISCUSSION/SIGNIFICANCE OF IMPACT: To the best of our knowledge, this is the first study to use radiomic-based machine learning models for the prediction of tissue ischemia, specifically intestinal ischemia in the setting of PI. In this preliminary study, which serves as a proof of concept, the performance of our models has demonstrated the potential of machine learning based only on radiomic imaging features to have discriminative power for surgical decision-making problems. While many non-imaging-related clinical factors play a role in the gestalt of clinical decision making when PI presents, we have presented radiomic-based models that may augment this decision-making process, especially for more difficult cases when clinical features indicating acute abdomen are absent. It should be noted that prediction task 2, whether or not a patient presenting with PI would benefit from an operation, has lower performance than prediction task 1 and is also a more challenging task for physicians in real clinical environments. While our results are promising and demonstrate potential, we are currently working to increase our dataset to 300 patients to further train and assess our models. References DuBose, Joseph J., et al. “Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma.” Journal of Trauma and Acute Care Surgery 75.1 (2013): 15-23. Knechtle, Stuart J., Andrew M. Davidoff, and Reed P. Rice. “Pneumatosis intestinalis. Surgical management and clinical outcome.” Annals of Surgery 212.2 (1990): 160.

Factors relating to the publication rate of abstracts presented from 2012 to 2015 at the Society for Vascular Surgery Annual Meeting

ObjectiveThe Society for Vascular Surgery's Annual Meeting acts as a means of disseminating research findings among vascular surgeons through the presentation of research abstracts. Following presentation at the meeting, research is often compiled into a full-text manuscript and submitted to a peer-reviewed journal. However, not all abstracts accepted to the Vascular Annual Meeting (VAM) eventually have a corresponding full-text publication. The objectives of this study were to establish the publication rate of abstracts presented between 2012 and 2015 to the VAM and to identify factors correlating with publication status. MethodsAbstracts presented at the VAM were available through the Journal of Vascular Surgery. Data extracted from eligible abstracts included level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence scheme, type of study (prognostic, therapeutic/harm, diagnostic), sample size, and status of outcome (positive, negative, or descriptive findings). Publication status of the abstracts was determined through a comprehensive literature review of PubMed (MEDLINE), Ovid (MEDLINE), and Embase. A multivariable logistic regression was conducted to determine factors correlating with publication status. ResultsThe publication rate during the study period was 43.0% with a median time to publication of 9 months, with 412 of the 958 abstracts having a corresponding full-text publication in 48 journals with weighted mean impact factor of 3.40. Eleven journals collectively published 372 (90.3%) of the articles, with the Journal of Vascular Surgery publishing 280 (68.0%) of the manuscripts. Our logistic regression model demonstrated that factors positively affecting publication status were a positive status of outcome (odds ratio, 2.59; 95% confidence interval, 1.56-4.28) and a logarithmic increase in the sample size of the study (odds ratio, 1.35; 95% confidence interval, 1.13-1.60). In addition, studies with a corresponding full-text publication had a greater median sample size (250) compared with those without one (143; P < .001). ConclusionsFrom 2012 to 2015, 43.0% of VAM abstracts had a corresponding full-text publication, with greater sample size and a positive status of outcome positively correlating with likelihood of publication. Studies with negative findings made up a small proportion of conference abstracts (9.6%) and were the least likely to be published. Given the relatively small size of the specialty of vascular surgery, it may be particularly important to be mindful of publication bias. It may be worthwhile to give additional consideration to acceptance of abstracts or publication of studies with negative results that meaningfully contribute to the literature.

International and Geographic Trends in Gender Authorship within Plastic Surgery.

Professional advancement in academic plastic surgery may depend on scholarly activity. The authors evaluate gender-based publishing characteristics in three international plastic surgery journals. A retrospective review of all articles published in 2016 in the following journals was undertaken: Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, European Journal of Plastic Surgery, Annals of Surgery, and New England Journal of Medicine. Data were collected on lead author gender (first or senior author) and differences in author gender proportions, by journal, by article topic, and by geographic location were evaluated. Overall, 2610 articles were retrieved: 34.1 percent were from plastic surgery journals, 12.8 percent were from the Annals of Surgery, and 53.1 percent were from the New England Journal of Medicine. There was a lower proportion of female lead authors among plastic surgery journals compared with the Annals of Surgery and the New England Journal of Medicine (31 percent versus 39 percent versus 39 percent; p = 0.001). There were no differences in female lead author geographic location in the Annals of Surgery or the New England Journal of Medicine; within the plastic surgery journals, there were differences (p = 0.005), including a lower proportion arising from East Asia (15 percent) and a higher proportion arising from Canada (48 percent). Within plastic surgery, Plastic and Reconstructive Surgery had the lowest proportion of female lead author (p < 0.001). The proportion of female lead author varied by article topic (p < 0.001) and was notably higher in breast (45.6 percent) and lower in head and neck/craniofacial-orientated articles (25.0 percent). There are gender disparities in three mainstream plastic surgery journals-Plastic and Reconstructive Surgery, the Journal of Plastic, Reconstructive and Aesthetic Surgery, the European Journal of Plastic Surgery-and there are lower proportions of lead female authorship compared with the Annals of Surgery and the New England Journal of Medicine. Further research should focus on understanding any geographic disparities that may exist.

Spotlight in Plastic Surgery: January 2019

Spotlight in Plastic Surgery: January 2019

Los top 100. Revisión de los artículos más citados en cirugía

IntroductionWe performed a study of the top 100 most cited articles in the five general surgery journals with the highest impact according to Journal Citation Report. MethodsWe selected the five journals with the highest impact in 2015: Annals of Surgery, British Journal of Surgery, JAMA Surgery, Surgery, and Journal of the American College of Surgeons. In January 2017, using the Web of Science application, we performed a search of all articles published by these journals and identified the 100 most cited articles (top 100). We evaluated the number of citations, year of publication, type of article, country and hospital of the article, area of interest and number of authors. ResultsThe median number of citations per top 100 paper was 490. Twenty percent of the top 100 papers have been published since 2000. Overall, 70% are original papers, 8% randomized control trials, 11% reviews, 1% meta-analyses and 11% other subtypes. There are 13% proceedings papers. Sixty-one percent are from the US. The most frequently discussed topic is hepato-pancreato-biliary surgery (33%). ConclusionsThe top 100 most cited articles tend to be original articles describing studies carried out in the US, reporting significant surgical breakthroughs. Hepato-pancreato-biliary surgery is the most common subject area. Annals of Surgery had twice as many citations as the other journals studied. The archetypal article of the Top15 most cited is an original paper published in the twentieth century, with an average of 2000 citations.

Occult Breast Cancer

Today breast cancer is the most common cancer type in women, in both developed and developing countries. However, occult breast cancer is a highly rare type in all breast cancers. For the first time in history to know, Halsted defined the term “occult breast cancer” with 2 cases of his’ in the journal, Annals of Surgery. We have 2 similar cases who were 52 and 61-years-old patients and presented our clinic with left axillary swelling and pain. On physical examination and with imaging techniques there wasn’t any primary lesion found. Examination of lymph nodes’ biopsy material was compatible with breast cancer metastasis for both of the patients and they were diagnosed with occult breast cancer. They underwent a modified radical mastectomy surgery and axillary curettage. Histopathologic examination of the excised breast material revealed T1 invasive breast cancer.International Journal of Human and Health Sciences Vol. 02 No. 04 October’18. Page : 239-243

Using Bradford's law of scattering to identify the core journals of pediatric surgery

BackgroundBradford's law of scattering defines an exponentially diminishing return when extending a search for references in journals and can be used to identify the “core” journals in a field. The purpose of this study was to identify the core journals of pediatric surgery. MethodsWith Institutional Review Board approval, we developed bibliometric profiles for the top academically productive pediatric surgeons in the United States. These profiles included the total number of publications, journals in which those authors published their manuscripts, and identification of all articles cited by those surgeons, along with the journals those references were drawn from. Bradford's law of scattering was applied to identify the core journals of pediatric surgery. ResultsWe identified n = 69 pediatric surgeons (10 ± 0.2 5-year h-index). These authors published 10,031 articles (145 ± 90 per surgeon), which were cited 250841 times (3635 ± 413 per surgeon). Pediatric surgeons' articles contained 199507 references (2891 ± 176 per surgeon). We analyzed 58,310 references (top 20 journals) cited by pediatric surgeons. Bradford's Law identified a single core journal for p = 3-10 zones, with P = 3, providing the best correlation between predicted and actual values (Rˆ2 = 0.9996). The core journal for pediatric surgery is Journal of Pediatric Surgery. ConclusionsWe used Bradford's Law to identify the core journals of pediatric surgery. These core journals include the two leading pediatric surgery–specific journals and the highest impact factor journals in surgery (Annals of Surgery) and medicine (NEJM). These findings can help busy pediatric surgeons focus their reading to stay updated in a rapidly evolving field.

The 100 most-cited papers in general thoracic surgery: A bibliography analysis

BackgroundThe status of citations can reflect the impact of a paper and its contribution to surgical practice. The aim of our study was to identify and review the 100 most-cited papers in general thoracic surgery. Materials and methodsRelevant papers on general thoracic surgery were searched through Thomson Reuters Web of Science in the last week of November 2017. Results were returned in descending order of total citations. Their titles and abstracts were reviewed to identify whether they met our inclusion criteria by two thoracic surgeons independently. Characteristics of the first 100 papers, including title, journal name, country, first author, year of publication, total citations, citations in latest 5 years and average citation per year (ACY) were extracted and analyzed. ResultsOf the 100 papers, the mean number of citations was 322 with a range from 184 to 921. 19 journals published the papers from 1956 to 2012. Annals of Surgery had the largest number (29), followed by Journal of Thoracic and Cardiovascular Surgery (22) and Annals of Thoracic Surgery (21). The majority of the papers were published in 2000s (48) and originated from United States of America (62). There were 65 retrospective studies, 13 RCTs and 11 prospective studies. Orringer MB and Grillo HC contributed 4 first-author articles respectively. There were 53 papers on esophagus, 36 on lung, 6 on pleura and 5 on trachea. ConclusionsOur study identified the most-cited papers in the past several decades and offered insights into the development and advances of general thoracic surgery. It can help us understand the evidential basis of clinical decision-making today in the area.

Association of Author Gender With Sex Bias in Surgical Research

Previous studies demonstrate sex bias in surgical research. Female participants and investigators are underrepresented in surgical scientific research. To describe the distribution of male and female authors in 5 general-interest surgery journals, assess the association of author gender with sex bias, and explore whether investigators benefit from performing sex-inclusion research. For this bibliometric analysis, data were abstracted from 1921 original, peer-reviewed articles published from January 1, 2011, through December 31, 2012, in Annals of Surgery, American Journal of Surgery, JAMA Surgery, The Journal of Surgical Research, and Surgery. Excluded articles pertained to a sex-specific disease or did not report the number of study participants. An additional 119 articles contained gender-ambiguous author names and were omitted. Data were analyzed from April to June 2017. Male and female first and senior authors, number of female and male participants in each study, surgical specialty, and number of citations received per article. Of the 3604 authors of 1802 articles included in this study, 2791 first and senior authors (77.4%) were male and 813 (22.6%) were female. The prevalence of male and female authors was consistent across all 5 journals and among clinical and basic science research. Articles by female authors included a higher median number of female study participants compared with their male counterparts (27.5 vs 16.0; P = .01), but sex matched the inclusion of participants less frequently (36% vs 45%; P = .001). No sex-based differences occurred between male and female authors in reporting, statistical analysis, and discussion of the data or in the number of citations received. Compared with studies that did not report, analyze, or discuss data by sex, studies that performed sex-specific data reporting yielded a mean of 2.8 more citations (95% CI, 1.2-4.4; P = .001); those that performed statistical analysis, a mean of 3.5 more citations (95% CI, 1.8-5.1; P = .001); and those that discussed the data, a mean of 2.6 more citations (95% CI, 0.7-4.5; P = .001). Articles with a higher percentage of sex matching of participants also received more citations, with an increase of 1 citation per 4.8% (95% CI, 2.0%-7.7%; P = .001) increase in percentage of sex matching. Sex bias in surgical research is prevalent among male and female authors; however, female authors included proportionally more female participants in their studies compared with male authors. Notably, studies that addressed sex bias were rewarded by the scientific community with increased citations of their published work.

Impact of Escalating Cognitive Workload and Temporal Demands on Surgeons Cognitive Function

Impact of Escalating Cognitive Workload and Temporal Demands on Surgeons Cognitive Function