Impact factors of orthopaedic journals between 2000 and 2010: trends and comparisons with other surgical specialties

Journal Metrics of Orthopaedic Journals between 2016 and 2021: Trends and Comparisons with Other Specialties

Bibliometric analysis plays a crucial role in elucidating publication trends and aids scholars in gauging the reach of prospective journals for their research dissemination. Concerns with impact factor (IF) have led us to examine the trends in IF, corrected IF (cIF), and Citescore in orthopaedic journals from 2016 to 2021 and compare them with internal medicine and general surgery journals. Journal IF and cIF were obtained from Journal Citation Reports and Citescore data from the Elsevier Scopus database for the years 2016 to 2021. Orthopaedic journals were categorized, and 10 medicine and surgery journals were selected for comparison. Mean values were analyzed to identify trends. The study included 52 orthopaedic journals, evenly split between the United States and the rest of the world, predominantly publishing in English. Mean IF in orthopaedic journals increased from 1.93 (2016) to 2.78 (2021), with similar rises in cIF and Citescore. These trends were consistent in specialty and general orthopaedic journals. No significant differences were found in mean IF between these categories. Medicine and surgery journals also experienced significant IF increases. Orthopaedic journals have experienced growing esteem and extent from 2016 to 2021. Specialty and general orthopaedic journals showed parallel growth. Researchers can utilize this analysis for informed publishing decisions, potentially expanding their readership.

Bibliometric analysis of orthopedic theses in Turkey

Objectives

This study aims to investigate the topics distribution trend and evaluate the characteristics of orthopedics and traumatology residency theses during a 20-year period using a bibliometric analysis.

Materials and methods

Between January 2000 and December 2020, orthopedics and traumatology residency theses of all centers providing postgraduate education in Turkey were reviewed from the online application of the National Thesis Center of Higher Education Council. Using the advanced search screen, a total of 1,907 theses were reached. Massachusetts University Orthopaedics and Traumatology Fellowship Programs and Turkish Society of Orthopaedics and Traumatology sub-study groups.

Results

During the study period, the three most studied topics ones were orthopedic trauma (n=536; 28.1%), adult reconstruction and arthroplasty (n=301; 15.8%) and spine surgery (n=203; 10.6%). The least studied subject was bone and soft tissue tumors with 3.8% (n=73). The topic with the highest rate of publication in all years was again orthopedic trauma. There was a very strong positive (r=0.876) correlation between the total number of thesis publications and the years (p<0.001; R2=0.767). Based on institutions types, the number of theses published in the training and research hospitals increased as of 2016. More theses were published than expected on orthopedic trauma, adult reconstruction and arthroplasty, sports injuries and arthroscopy, shoulder and elbow surgery, foot and ankle surgery in the training and research hospitals (p=0.003).

Conclusion

The orthopedic research trends were differentiated over the years in our country. The classification of the orthopedic thesis topics shows in which orthopedics subfield research subjects are concentrated in our country and in which fields, research is needed.

Major Orthopaedic Conference Abstract Publication: An Analysis of Abstracts Accepted for the AAOS Annual Meetings Between 2014 and 2017

INTRODUCTION

The American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting provides an opportunity for clinicians to attain the most recent advancements in the orthopaedic field. However, the most recent study analyzing publication rates from the 2001 Annual Meeting determined that only 49% of the podium and poster abstracts were eventually published. The purpose of this study was to determine the publication rate, likelihood of publication based on the presentation format, and time to publication for abstracts presented at the 2014 to 2017 AAOS Annual Meetings.

METHODS

We did a comprehensive search of PubMed and Google Scholar to determine whether abstracts presented in the podium, poster, and scientific exhibit formats from the 2014 to 2017 AAOS Annual Meetings were published in a peer-reviewed journal. Abstract title, authors, and keywords were used to query for publication status and date of publication.

RESULTS

We analyzed 5,902 abstracts from the 2014 to 2017 AAOS Annual Meetings. The overall publication rate for podium and poster presentations was 69.9%, with individual publication rates at 73.0% and 65.1%, respectively. A higher likelihood of publication in the podium format was noted with odds ratio 1.45 (P < 0.0001). Scientific exhibits displayed a publication rate of 46.9%. Most publications in all formats occurred within 2 years.

CONCLUSION

A large increase was noted in the quality of research being presented at the AAOS Annual Meeting. With 69.9% of podium and poster presentations from the 2014 to 2017 Annual Meetings being published in a peer-reviewed journal, clinicians can use the data presented as an up-to-date, adjunct source of guidance for their clinical practices.

The Evolving Trends in the Impact Factor of Plastic Surgery Journals: A 22-Year Analysis

BACKGROUND

The journal impact factor (IF) is one of the most widely adopted metrics to assess journal value. We aimed to investigate the trends in the IF and ranking of plastic surgery journals (PSJs) over a 22-year period.

METHODS

The Journal Citation Report 2018 was used to identify all journals within the field of plastic surgery from 1997 to 2018. We analyzed the IF of PSJs and that of the category surgery.

RESULTS

A total of 34 PSJs were identified. The mean IF increased from 0.584 (median, 0.533) in 1997 to 1.58 (median, 1.399) in 2018 (P < 0.0001). Over the same time, the median IF of the journals in the category surgery increased from 0.914 to 1.883. The mean journal IF percentile of PSJs within surgery remained fairly stable (P = 0.999). A strong positive correlation was identified between the IF of PSJs and both the 5-year IF (r = 0.943, P < 0.0001) and the immediacy index (r = 0.736, P < 0.0001). The percentage of self-citations across the study period was fairly stable at a mean of 19.2%. A weak positive correlation was found between the IF and the percentage of self-citations (r = 0.171, P < 0.0001).

CONCLUSIONS

The mean journal IF in PSJs has been trending upward over the last 22 years. Ranking of PSJs IF within the category surgery has remained unchanged. The self-citation rate has been fairly stable and correlated weakly with the IF. A strong positive correlation exists between the IF and both the immediacy index and the 5-year IF.

Twenty Five-Year Publication Trends in Foot and Ankle Literature: Improved Methodological Quality and Internationality With Time

Background:

Methodological quality and author internationality are increasing in orthopaedic surgery. The purpose of this study was to evaluate the methodological quality and author geography trends from 1994 to 2019 in high-quality foot and ankle journals.

Methods:

Analyses of 1,242 foot and ankle publications in Foot and Ankle International, American Journal of Bone and Joint Surgery, and American Journal of Sports Medicine were done for 1994, 1999, 2004, 2009, 2014, and 2019. Articles were classified according to study type, level of evidence (LOE), and author's country of publication.

Results:

The most common clinical study was therapeutic (65.4). Significant increases were noted in the proportion of therapeutic (P < 0.01) and prognostic (P < 0.01) articles. The average LOE increased from 3.96 ± 1.01 to 3.19 ± 0.97 (P < 0.01). The proportion of Level I (P = 0.29) and level IV articles (P = 0.21) remained constant, level II (P < 0.01) and level III (P < 0.01) articles increased, and level V (P < 0.01) articles decreased. United States authorship decreased from 78.1% in 1994 to 44.8% in 2009, then remained constant through 2019 (P < 0.01).

Conclusion:

This study demonstrated an improvement in LOE of foot and ankle publications across a 25-year period in three high-quality orthopaedic journals. Increasing internationality was also observed.

The Proportion of Abstracts Presented at the 2010 American Academy of Orthopaedic Surgeons Annual Meeting Ultimately Published

As attendees of orthopedic meetings consider how to integrate presented information into their practice, it is helpful to consider the quality of the data presented. One surrogate metric is the proportion of and changes to presented abstracts that become journal publications. With this study, using the 2010 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting abstracts, the authors sought to answer the following questions: Did the publications following abstract presentations differ in terms of the conclusions, study subjects, or coauthors? What proportion of abstracts was published? What are the most common subtopics and journals, and what is the most common author country? Keywords and authors from the 2010 AAOS Annual Meeting proceedings program (698 podium and 548 poster abstracts) were searched in PubMed, Embase, and Google Scholar. If a publication resulted, differences in the conclusion, number of study subjects, and authorship between the abstract and the journal publication were tabulated. The proportion of abstracts published, specialty subtopics, authorship country, and journals of publication were collected. At journal publication, 1.7% of podium and 1.7% of poster conclusions changed. Mean number of authors for podium and poster increased significantly (P<.001), and 30% of podium and 44% of poster had a change in the number of study subjects. The overall journal publication percentage was 61% (68% podium and 53% poster). The majority of the authors were from the United States. The most common journal was The Journal of Bone & Joint Surgery. It is important to evaluate the usefulness and clinical applicability of meetings, especially the final disposition of conference abstracts, from various angles to ensure that they are as worthwhile and educational as possible. [Orthopedics. 2020;xx(x):xx-xx.].

Does the h-index and self-citation affect external funding of orthopedic surgery research? An analysis of fellowship directors and their subspecialties

Purpose

Determine the impact of self-citation on external funding for orthopedic fellowship directors.

Methods

The San Francisco Match's website identified directors encompassing 8 subspecialties. The Scopus database identified the number of publications, citations, and h-index for each director. H-index was assessed with/without self-citation.

Results

Mean publications, citations, self-citation rate, and h-index for the 446 directors were 71.2, 1816, 3.86%, and 18.3, respectively. Excluding self-citations reduces mean h-index to 18.0; and h-index changed by ≤ 1 integer in 95% of directors.

Conclusions

Self-citation has minimal impact among fellowship directors and should not be adjusted for when considering external funding.

Pediatric supracondylar humerus fractures and vascular injuries: A cross-sectional study based on the National Trauma Data Bank

OBJECTIVE

Supracondylar humerus (SCH) fractures represent one of the most commonly treated fractures. We sought to determine: 1) how often SCH fractures are associated with vascular injury; 2) mechanism of injuries; 3) where cases are treated 4) time to operating room (OR); and 5) length of stay (LOS).

METHODS

The 2007-2014 National Trauma Data Bank (NTDB) data were analyzed for all patients <18 years of age who presented with an isolated supracondylar humerus fracture, with or without an associated vascular injury. Both non-operative and operative management were included. Main outcome measures were demographics, mechanism of injury, presence of vascular injury, time to OR, number of OR procedures, type of treating facility, and LOS. Comparisons were performed using Chi square test for categorical variables and Student's t-test for continuous variables.

RESULTS

We identified a total of 53,571 pediatric patients over eight years with SCH fractures. Vascular injuries occurred in 149 patients (0.3%), which were significantly more common with open fractures (p < 0.001). Patients with vascular injuries had significantly longer LOS (3.5 days v 1.4 days; p < 0.001) and shorter times to the OR (4.7 h v 10.4 h; p < 0.001), and were more likely to be treated in teaching hospitals and pediatric level 1 trauma centers (p = 0.037).

CONCLUSION

The percentage of vascular injuries associated with SCH fractures in pediatric patients remains low (0.3%). The majority of pediatric patients with these injuries are treated at level 1 pediatric trauma centers.

LEVEL OF EVIDENCE

Therapeutic, III.

Publication integrity in orthopaedic journals: the self-citation in orthopaedic research (SCOR) threshold

BACKGROUND

The impact factor (IF) is the most commonly used bibliometric method for rating academic journals. However, the practice of journals' self-citation may artificially elevate the IF. Additional bibliometric methods including Eigenfactor scale, SCImago Journal Ranking (SJR), and corrected IF (cIF) have been created. Comparing general-interest and specialized orthopaedic journals, the aims of this study were to assess: (1) the effect of journal´s self-citation on IF; (2) differences in bibliometric analysis; and (3) to determine thresholds for monitoring self-citation practices by defining the self-citation in orthopaedic research (SCOR) Threshold.

METHODS

The journal citation reports and SCImago Journal and Country Rank databases were queried for orthopaedic journals from 1997 to 2017. The following bibliometrics were compared between general-interest and specialized journals: IF, cIF, Eigenfactor, self-citation rates, and SJR. A novel metric, the cIF ratio, was proposed to represent the relationship between a journal's IF and cIF. Thresholds for cIF were based on statistical outliers of cIF ratio within general-interest and specialized journals were calculated. Outliers were defined as data points that were greater than the third quartile by 1.5 times the interquartile range using the last 10 years studied (2007-2017).

RESULTS

Specialized orthopaedic journals had a higher median self-citation rates compared to general-interest journals (11.85% vs. 6.36%, p < 0.001). Overall, cIF ratio declined over study period, and general-interest journals had a lower cIF ratio than specialized journals (8.77% vs. 19.54%, p < 0.001). Overall, general-interest journals had more favourable values for the bibliometric indices studied compared to specialized journals The SCOR threshold for cIF ratio was determined as 25.4% for general-interest journals and 53.3% for specialized journals.

CONCLUSION

Overall, self-citation occurs at a higher rate in specialized versus general-interest orthopaedic journals. We propose the use of a cIF ratio along with the SCOR threshold as a tool to evaluate and monitor journal self-citation practices in orthopaedic research.

Abstracts Accepted for Presentation at Orthopaedic Trauma or Arthroplasty Conferences: Which Conference Is the Best Indicator of Future Publication?

Time and financial resources pose limitations to orthopaedic surgeons wishing to advance their orthopaedic knowledge, and surgeons frequently must choose one meeting to attend. We sought to determine whether abstracts presented at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting or the trauma (Orthopaedic Trauma Association [OTA]) or arthroplasty (American Association of Hip and Knee Surgeons [AAHKS]) subspecialty meetings, respectively, were higher yield with respect to material ultimately being published. We hypothesized that papers accepted by AAOS would demonstrate higher conversion to publication compared with OTA and AAHKS but expected abstract publication rates from OTA and AAHKS to be similar.

Primary outcome measures used in interventional trials for ankle fractures: a systematic review

Background

Ankle fractures cause considerable pain, loss of function and healthcare resource use. High quality randomised controlled trials are required to evaluate the optimal management protocols for ankle fracture. However, there is debate regarding the most appropriate outcome measure to use when assessing patients with ankle fractures. The aim of this systematic review is to identify and summarise primary outcome measure use in clinical trials of non-pharmacological interventions for adults with an ankle fracture.

Methods

We performed comprehensive searches of the Medline, Embase, CINAHL, AMED and Cochrane CENTRAL databases, as well as ISRCTN and ClinicalTrials.gov online clinical trial registries on 19/06/2019 with no date limits applied. The titles and abstracts were initially screened to identify randomised or quasi-randomised clinical trials of non-pharmacological interventions for ankle fracture in adults. Two authors independently screened the full text of any articles which could potentially be eligible. Descriptive statistics we used to summarise the outcome measures collected in these articles including an assessment of trends over time. Secondary analysis included a descriptive summary of the multi-item patient reported outcome measures used in this study type.

Results

The searches returned a total of 3380 records. Following application of the eligibility criteria, 121 records were eligible for inclusion in this review. The most frequently collected primary outcome measures in this type of publication was the Olerud Molander Ankle Score, followed by radiographic and range of movement assessments. There was a total of 28 different outcome measures collected and five different multi-item, patient reported outcome measures collected as the primary outcome measure. There was a sequential increase in the number of this type of study published per decade since the 1980’s.

Conclusion

This review demonstrates the wide range of measurement methods used to assess outcome in adults with an ankle fracture. Future research should focus on establishing the validity and reliability of the outcome measures used in this patient population. Formulation of a consensus based core outcome set for adults with an ankle fracture would be advantageous for ensuring homogeneity across studies in order to meta-analyse trial results.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2770-2) contains supplementary material, which is available to authorized users.

Increased Utilization of American Administrative Databases and Large-scale Clinical Registries in Orthopaedic Research, 1996 to 2016

Introduction

Administrative databases and clinical registries provide large sample sizes that characterize specific outcomes and trends over time in orthopaedic surgery.

Methods

A literature review of all English-language orthopaedic surgery journals was conducted. All publications from 1996 to 2016 were reviewed for the utilization of an administrative database or clinical registry. We performed a linear regression with logarithmic transformation to identify trends in database utilization.

Results

Eight hundred forty-nine publications used a database from 1996 to 2016. Each year, 35.3% more database publications are reported than the previous year (95% confidence interval, 30.0 to 40.7), from zero articles in 1996 to 286 in 2016. The ratio of database research publications to overall orthopaedic publications increased from zero in 1996 to 2% in 2016. The most commonly used databases included the National Inpatient Sample and the National Surgical Quality Improvement Program.

Conclusion

Database research in orthopaedics has grown at a faster rate than orthopaedic literature as a whole.

Manuscript Submission Patterns of Authors Publishing in Orthopaedic Sports Medicine Journals

Background

Previous studies have examined the most cited articles in orthopaedic sports medicine research and the journals in which they were published.

Purpose

To analyze the manuscript submission patterns of authors who published manuscripts in various orthopaedic sports medicine journals.

Study Design

Cross-sectional study.

Methods

All articles published in the March 2017 and April 2017 issues of Arthroscopy, the American Journal of Sports Medicine (AJSM), Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), and the Orthopaedic Journal of Sports Medicine (OJSM) were searched. In addition, the past 50 sports medicine-related articles published in the Journal of Bone and Joint Surgery (JBJS) dating back from April 2017 to May 2015 were searched. The corresponding author of each article was asked whether the publishing journal was the first journal of submission. If the article was previously submitted elsewhere, authors were asked which other journals, the dates of submission, and the order of submission. The proportion of articles that were initially submitted to each journal, the mean number of submissions prior to publication, and the mean duration from initial submission to date of publication were calculated for each journal.

Results

A total of 298 articles were included in this study, and 221 (74%) corresponding authors responded to the survey. The mean number of submissions before acceptance was 1.05 for AJSM, 1.18 for JBJS, 1.20 for KSSTA, 1.38 for Arthroscopy, and 2.19 for OJSM. The percentage of articles that were submitted to their accepting journal first (ie, not previously submitted elsewhere) was 95% for AJSM, 85% for JBJS, 82% for KSSTA, 68% for Arthroscopy, and 13% for OJSM.

Conclusion

Among the orthopaedic sports medicine journals included in this study, articles published in AJSM have the highest percentage of first submissions.

Adult Reconstruction Studies Presented at AAOS and AAHKS 2011-2015 Annual Meetings. Is There a Difference in Future Publication?

BACKGROUND

The purpose of this study was to compare adult reconstruction abstracts presented at the American Academy of Orthopaedic Surgeons (AAOS) and the American Association of Hip and Knee Surgeons (AAHKS) annual meetings.

METHODS

A total of 1355 podium and 1731 poster presentations from the adult reconstruction sections of the AAOS and AAHKS meetings from 2011 to 2015 were reviewed for publication in peer-reviewed literature. Authors who were added or removed from the original abstract and the final manuscript were recorded. The corresponding journals were assigned the most recent impact factor. The publication rates for each annual meeting, the mean changes in authorship and journal's impact factors were compared.

RESULTS

There were 2129 abstracts presented at AAOS and 957 abstracts presented at AAHKS. The overall publication rate was different between AAOS and AAHKS (56% vs 60%, P = .030). Compared with AAOS, there were more AAHKS abstracts published in 2011 (57% vs 77%, P = .0008) and 2012 (57% vs 76%, P = .0001); however, there were no significant differences in 2013, 2014, or 2015. The mean overall change in authors was lower for AAOS compared with AAHKS abstracts (0.78 vs 1.06, P < .0001). The mean journal's impact factors for AAOS and AAHKS publications were also similar (2.86 vs 2.85, P = .874).

CONCLUSION

AAOS and AAHKS abstracts presented in the adult reconstruction subspecialty had a similar overall rate of publication, change in authorship, and impact factor. It would be beneficial if further studies subdivided these into basic and clinical science and review articles.

Impact factors of orthopaedic journals between 2010 and 2016: trends and comparisons with other surgical specialties

Background

With increased legislative efforts to utilize evidence-based medicine as a guide for clinical practice, orthopaedists feel increasing pressure to publish research in higher-quality journals that reach a larger audience. Impact factor (IF) is used to quantify and rank journal apparent quality, and is the most standardized method for journal appraisal. In this study, we assessed the trends for IF among orthopaedic journals and compared these trends to those of medicine and general surgery journals.

Methods

Journal IFs from Journal Citation Reports (JCR) between the years 2010 to 2016 were obtained and analyzed for trends. Only journals that were considered primarily orthopaedic journals were included. The top 10 journals by IF in both internal medicine and surgery were also included for comparison. Each journal was analyzed by IF, and trends across time were noted. The differences in mean IF between orthopaedic specialty groups were analyzed using an independent samples t-test.

Results

The mean IF of orthopaedic increased from 1.4 (range, 0.0-3.9) in 2010 to 1.9 (range, 0.5-5.7) in 2016. In 2016, the percentage of English journals increased to 87.3% (n=48), while the percentage of journals published in the United States was 47.3% (n=26). There was a significant difference between the IF of journals published in English and those published in other languages (P=0.004). The mean IF of both general and specialized orthopaedic journals increased from 2010 to 2016, but the difference was nonsignificant. The mean IF of the top 10 journals in both surgery and internal medicine also increased from 2010 to 2016, but the increase was also nonsignificant.

Conclusions

Overall, the mean IF for peer-reviewed orthopaedic journals has increased in the past years, as has the number of journals. English journals from the United States continue to have the largest impact when compared to non-English journals and journals from outside the United States. Future studies should aim to better qualify journal impact, while limiting confounders such as self-citation.

Comparison of 30-Day Complications Between Navigated and Conventional Single-level Instrumented Posterior Lumbar Fusion: A Propensity Score Matched Analysis

STUDY DESIGN

Retrospective cohort comparison study.

OBJECTIVE

To compare perioperative outcomes between navigated and conventional single-level instrumented posterior lumbar fusions in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

SUMMARY OF BACKGROUND DATA

Although multiple studies have investigated the accuracy of pedicle screw placement and radiation exposure with navigation, no study has compared perioperative complications between navigated and conventional posterior lumbar fusion. The potential benefits of navigation include improved accuracy of screw placement and reduced surgeon radiation exposure, but this is balanced by potential operative time and surgical site contamination/infection related to this bulky technology.

METHODS

Patients who underwent navigated or conventional single-level posterior instrumented lumbar fusions were identified in the 2010-2015 NSQIP database. The usage of navigation was characterized. Patient characteristics and comorbidities were compared between the two treatment groups. Propensity score matching was done and comparisons were made for operative time, hospital length of stay, postoperative complications, and 30-day readmissions between the two cohorts.

RESULTS

The percentage of navigated cases tended to increase over years studied to approximately 10%. After propensity matching to control potential confounding factors, statistical analysis revealed no significant difference in operative time and for most adverse events including wound infection, return to the operating room, and readmission. There were significantly lower blood transfusions in the navigated cohort (2.84% vs. 7.15%, P < 0.001). Patients who underwent navigated surgery also had a shorter mean hospital length of stay (0.2 day difference, P = 0.016).

CONCLUSION

The reduced blood loss and mildly reduced hospital length of stay identified for the navigated cases are probably markers of more minimally invasive surgery in the navigated cohort. The current study could not identify other differences in operative time, wound infection, or return to the operating room/readmission between navigated and conventional single level posterior instrumented lumbar cases.

LEVEL OF EVIDENCE

3.

Similar 30-Day Complications for Septic Knee Arthritis Treated With Arthrotomy or Arthroscopy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

PURPOSE

The purpose of the current study was to use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to determine whether there were differences in 30-day perioperative complications between open arthrotomy and arthroscopy for the treatment of septic knees in a large national sample.

METHODS

Patients who were diagnosed with a septic knee and underwent open arthrotomy or arthroscopy were identified in the 2005-2014 NSQIP data sets. Patient demographics and perioperative complications were characterized and compared between the 2 procedures.

RESULTS

In total, 168 patients undergoing knee arthrotomy and 216 patients undergoing knee arthroscopy for septic knee were identified. There were no statistically significant differences in demographic variables between the 2 groups. On univariate analysis, the rate of minor adverse events (MAEs; 15.48% vs 8.80%, P = .043) was higher in the open arthrotomy treatment group, while the rate of serious adverse events (SAEs; 37.50% vs 26.19%, P = .019) was higher in the arthroscopic surgery treatment group. On multivariate analysis, which controlled for patient characteristics/comorbidities and used the Bonferroni correction for multiple comparisons, there were no statistically significant differences in risk of any adverse events (relative risk [RR] = 0.851; 99% confidence interval [CI], 0.598-1.211; P = .240), MAE (RR = 1.653; 99% CI, 0.818-3.341; P = .066), SAE (RR = 0.706; 99% CI, 0.471-1.058; P = .027), return to the operating room (RR = 0.810; 99% CI, 0.433-1.516; P = .387), or readmission (RR = 1.022; 99% CI, 0.456-2.294; P = .944) between open compared with arthroscopic surgery.

CONCLUSIONS

Univariate analysis revealed a lower rate of MAE but a higher rate of SAE in the arthroscopic surgery treatment group. However, on multivariate analysis, similar perioperative complications, rate of return to the operating room, and rate of readmission were found after open and arthroscopic debridement for septic knees. Based on the lack of demonstrated superiority of either of these 2 treatment modalities for this given diagnosis, and the expectation that most differences in perioperative complications for this diagnosis would have declared themselves within the first 30 days, deciding between the studied treatment modalities may be based more on other factors not included in this study.

LEVEL OF EVIDENCE

Retrospective comparative study, Level III.

Comparison of Outpatient vs Inpatient Total Knee Arthroplasty: An ACS-NSQIP Analysis

BACKGROUND

There has been a recent surge of interest in performing primary total knee arthroplasty (TKA) in the outpatient setting to reduce cost and increase patient satisfaction. Detailed information on the safety of outpatient TKA in large sample sizes is scarce.

METHODS

Patients who underwent primary, elective TKA were identified in the 2005-2014 American College of Surgeons National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days, whereas inpatient procedure was defined as having a length of stay ≥1 days. To reduce the effect of confounding factors and nonrandom assignment of treatment, propensity score matching was used. Multivariate analyses on the matched samples were used to compare the rates of adverse events that happened any time during the 30-day postoperative period, postdischarge adverse events, and readmissions between the outpatient and inpatient cohorts.

RESULTS

A total of 112,922 TKA patients met the inclusion criteria. Of these, only 642 (0.57%) were outpatient procedures. Outpatients tended to be men, slightly younger, and have less comorbidity. After propensity matching, multivariate analysis revealed a higher rate of postdischarge blood transfusions (P < .001) in the outpatient cohort. There were no other significant differences in 30-day postoperative individual adverse events or readmissions.

CONCLUSION

Based on the perioperative outcome measures studied here, outpatient TKA can be appropriately considered in select patients based on rates of overall perioperative adverse events and readmissions. However, higher surveillance of these patients postdischarge may be warranted.

Does the Level of Evidence of Paper Presentations at the Arthroscopy Association of North America Annual Meetings From 2006-2010 Correlate With the 5-Year Publication Rate or the Impact Factor of the Publishing Journal?

PURPOSE

The purpose of this study was to determine the proportion of paper (podium) presentations at the 2006-2010 Arthroscopy Association of North America (AANA) annual scientific meetings that were ultimately published in a peer-reviewed journal. Furthermore, we aimed to evaluate whether the level of evidence correlated with the publication rate of these presentations or the impact factor (IF) of the publishing journal.

METHODS

Paper presentations from the 2006-2010 AANA annual meetings were included for evaluation. Clinical studies were graded for quality using the level of evidence by 2 independent reviewers. A comprehensive strategy was used to search the databases PubMed, Medline, and Embase for publications in scientific journals that corresponded to the presentations and were published within 5 years of the presentation date.

RESULTS

Three hundred twenty-eight presentations were evaluated. Overall, 179 peer-reviewed publications corresponding to particular meeting presentations were identified, for a 5-year publication rate of 55%. There was no correlation between the publication rate and the level of evidence (P = .836), the type of study (P = .628), or the joint of focus (P = .07) of the presentations. The mean IF of journals that published Level I studies (4.8 [standard error, 2.3]) was significantly higher than the mean IF of journals that published Level II, III, or IV studies (2.58 [standard error, 0.10]) (P = .017).

CONCLUSIONS

Between 2006 and 2010, presentations of the highest level of evidence at AANA meetings were subsequently published at a similar rate to presentations of lower levels of evidence, albeit in journals with higher IFs.

CLINICAL RELEVANCE

This study is an important initial evaluation of the ultimate clinical impact of AANA meeting presentations. The study type, joint of focus, and level of evidence of the presentations all had no correlation with the rate at which these presentations were ultimately published.

Trends in impact factors of ophthalmology journals

Purpose:

To test whether there is an association between the growth in the number of ophthalmic journals in the past years and their mean and maximum impact factor (IF) as a common sign of scientific proliferation.

Methods:

Using data from the 2013 Journal Citation Report database a study of the major clinical medical fields was conducted to assess the correlation between the number of journals and maximum IF in a given field in the year 2013. In the field of ophthalmology, we examined the correlation between year, number of journals, mean IF and maximum IF in the field of ophthalmology throughout the years 2000–2013.

Results:

In the major medical fields, a positive correlation was found between the number of journals and the maximum IF (quadratic R² = 0.71, P < 0.001). When studying the field of ophthalmology a positive correlation between the number of journals and mean IF (R² = 0.84, P < 0.001) and between number of journals and maximum IF (R² = 0.71, P < 0.001) was detected.

Conclusions:

Our findings suggest that the variation in the IF can be explained by the number of journals in the field of ophthalmology. In the future, the formation of additional ophthalmology journals is likely to further increase the IFs of existing journals.

Nationwide Databases in Orthopaedic Surgery Research

The use of nationwide databases to conduct orthopaedic research has expanded markedly in recent years. Nationwide databases offer large sample sizes, sampling of patients who are representative of the country as a whole, and data that enable investigation of trends over time. The most common use of nationwide databases is to study the occurrence of postoperative adverse events. Other uses include the analysis of costs and the investigation of critical hospital metrics, such as length of stay and readmission rates. Although nationwide databases are powerful research tools, readers should be aware of the differences between them and their limitations. These include variations and potential inaccuracies in data collection, imperfections in patient sampling, insufficient postoperative follow-up, and lack of orthopaedic-specific outcomes.

Do we really know our patient population in database research? A comparison of the femoral shaft fracture patient populations in three commonly used national databases

AIMS

While use of large national clinical databases for orthopaedic trauma research has increased dramatically, there has been little study of the differences in populations contained therein. In this study we aimed to compare populations of patients with femoral shaft fractures across three commonly used national databases, specifically with regard to age and comorbidities.

PATIENTS AND METHODS

Patients were identified in the Nationwide Inpatient Sample (NIS), National Surgical Quality Improvement Program (NSQIP) and National Trauma Data Bank (NTDB).

RESULTS

The distributions of age and Charleston comorbidity index (CCI) reflected a predominantly older population with more comorbidities in NSQIP (mean age 71.5; sd 15.6), mean CCI 4.9; sd 1.9) than in the NTDB (mean age 45.2; sd 21.4), mean CCI = 2.1; sd 2.0). Bimodal distributions in the NIS population showed a more mixed population (mean age 56.9; sd 24.9), mean CCI 3.2; sd 2.3). Differences in age and CCI were all statistically significant (p < 0.001).

CONCLUSION

While these databases have been commonly used for orthopaedic trauma research, differences in the populations they represent are not always readily apparent. Care must be taken to understand fully these differences before performing or evaluating database research, as the outcomes they detail can only be analysed in context.

TAKE HOME MESSAGE

Researchers and those evaluating research should be aware that orthopaedic trauma populations contained in commonly studied national databases may differ substantially based on sampling methods and inclusion criteria.

Conference Presentation Characteristics of Studies Published in The American Journal of Sports Medicine

BACKGROUND

Previous studies have determined the percentage of studies presented at national orthopaedic surgery meetings that are eventually published in peer-reviewed journals.

PURPOSE

To determine the proportion of articles in The American Journal of Sports Medicine (AJSM) that are presented at national or international meetings.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The AJSM archive of 2014 online issues was searched. All original research articles were searched for corresponding presentations as listed at the beginning of the manuscript. An email was sent to the corresponding author of all articles, including those with a presentation listed. Corresponding authors were asked if the published study was presented at a national or international meeting and, if so, at which meeting and year the study was presented. If the study was not presented at a national meeting, the corresponding author was asked why this was the case.

RESULTS

A total of 315 articles met the inclusion criteria. Presentation information was obtained for 264 of these articles (84%). Of these 264 studies, 218 (83%) were presented at national or international conferences. A total of 341 presentations were listed, including 144 (42%) at international conferences. The average time from first presentation to publication was 12.9 months. Seventy-two studies (72/218, 33%) were presented at more than 1 meeting. Of those studies presented at more than 1 meeting, the average number of presentations was 2.7 (range, 2-6). The most common conferences at which AJSM-published studies were presented were the American Orthopaedic Society for Sports Medicine (AOSSM) Annual Meeting (n = 56) and the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting (n = 43). Seven authors stated that their published studies were not presented because the study was not accepted for presentation at a national meeting.

CONCLUSION

A high proportion of studies accepted for publication in AJSM are presented at national and international meetings. AOSSM and AAOS Annual Meetings are the most common conferences at which these studies are presented, although international conferences account for a substantial proportion of AJSM-published study presentations.

The Impact Factor of Radiological Journals: Associations with Journal Content and Other Characteristics Over a Recent 12-Year Period

RATIONALE AND OBJECTIVES

The aim of this study was to evaluate the trends in the impact factor (IF) of radiological journals over a recent 12-year period, including associations between IF and journal topic.

MATERIALS AND METHODS

Journal Citation Reports (JCR) was used to identify all biomedical journals and all radiological journals (assigned a JCR category of "Radiology, Nuclear Medicine, & Medical Imaging"), along with journal IF, in 2003 and 2014. Radiological journals were manually classified by topic. Trends in median IF (mIF) were assessed.

RESULTS

The number of radiological journals increased from 83 (2003) to 125 (2014) (all biomedical journals: 5907 to 8718, respectively). mIF of radiological journals increased from 1.42 (2003) to 1.75 (2014) (all biomedical journals: 0.93 to 1.46, respectively). The most common topic among new radiological journals was general (nonspecialized) radiology (8). Five new radiological journals in 2014 were in topics (cancer imaging and molecular imaging) having no journals in 2003. mIF of general radiological journals was 1.49. Topics having highest mIF were cardiac imaging (2.94), optics (2.86), molecular imaging (2.77), radiation oncology (2.60), and neuroradiology (2.25). Topics with lowest mIF were ultrasound (1.19) and interventional radiology (1.44). Topics with the largest increase in mIF were cardiac imaging (from 1.17 to 2.94) and neuroradiology (from 1.07 to 2.25).

CONCLUSIONS

Radiological journals exhibited higher mIF than biomedical journals overall. Among radiological journals, subspecialty journals had highest mIF. While a considerable number of new radiological journals since 2003 were general radiology journals having relatively low IF, there were also new journal topics representing emerging areas of subspecialized radiological research.

Knee Society Award Papers Are Highly Cited Works

BACKGROUND

Since 1993, The Knee Society has presented three annual awards recognizing the best research papers presented at the annual meetings. To date, no quantitative evaluation has determined whether the selection process identifies the most meritorious papers based on subsequent citations. In the absence of validation of this process, it is unclear whether the journal readership should view the award-winning papers as those with potentially greater impact for the specialty.

QUESTIONS/PURPOSES

(1) Are award papers cited both more than nonaward papers published in the same Knee Society proceedings issue of CORR(®) and more than all other knee research papers published in all issues of CORR(®) during any given year? (2) Does the award selection process identify potentially highly influential knee research?

METHODS

Subsequent citations for each award and nonaward paper published in The Knee Society proceedings issue for 2002 to 2008 were determined using the SCOPUS citation index. The citations for all papers on knee surgery published in CORR(®) during the same years were also determined.

RESULTS

Mean citations for an award paper were statistically greater than for a nonaward paper: 86 (SD 95; median 55; 95% confidence interval [CI] of the mean, 44-128) versus 33 (SD 30; median 24; 95% CI of the mean, 28-37; p < 0.001). Mean number of citations for award papers was also higher than for all other knee research papers published in nonproceedings issues of CORR(®): 86 (SD 95; median 55; 95% CI of the mean, 44-128) versus 30 (SD 31; median 20; 95% CI for the mean, 25-35; p < 0.001). Twelve of the 22 (54.6%) award papers were in the top five cited papers from the proceedings issue for the respective year versus 24 of the 190 (12.6%) of the nonaward papers (difference in the percentages is 41.9% and the 95% CI for the risk difference is 20.6%-63.3%; p < 0.001). In 3 of 7 years, an award paper was the most cited knee paper published in CORR(®).

CONCLUSIONS

The selection process for The Knee Society scientific awards identifies potentially influential papers that are likely to be highly cited in future research articles about the knee.

CLINICAL RELEVANCE

The selection process for Knee Society Award Papers appears to identify papers that are potentially influential in the field of knee surgery and are likely to be highly cited in future published articles. As such, these award papers deserve special attention from the readership.

Bibliometric Analysis of Orthopedic Literature on Total Knee Arthroplasty in Asian Countries: A 10-year Analysis

Purpose

We aimed to determine the quantity and quality of research output of selected Asian countries in the field of total knee arthroplasty (TKA) in the last 10 years.

Materials and Methods

Top 15 Asian countries were selected according to their gross domestic product. The Science Citation Index Expanded database was used to search for the literature published between 2004 and 2013 using "Total Knee Arthroplasty". The numbers of articles, journals and citations and the contribution of each country were analyzed. The articles were classified according to the type of study and the relative proportion of each type was analyzed.

Results

Asian surgeons have increasingly contributed to orthopedic literature on TKA for the past 10 years, but the dominant contribution came from only a few countries. The total number of articles published by Asian countries increased by 261%, with Japan producing most of the studies and China showing the maximum growth rate. The majority of studies were published in low impact factor journals. Korea published the highest proportion of articles in high impact factor journals. Clinical papers were most frequent.

Conclusions

Our identification of research productivity pertaining to TKA among Asian countries gives a unique insight into the level of academic research in the field of TKA in these countries. There is a need to improve the quality of research to enhance the publishing power in high impact journals as well as the need for more basic research and epidemiological studies considering the unique differences among Asian patients undergoing TKA.

Development of obstetrical and gynecological journals, 2007 to 2013: a trend analysis

PURPOSE

To analyze the trends and developments among journals in the specialty of obstetrics and gynecology.

METHODS

Using the Journal Citation Reports from 2007 to 2013, we analyzed the impact factor (IF), Eigenfactor® Score (ES), and Article Influence® Score (AIS) of 43 journals in the field of obstetrics and gynecology published in this time period.

RESULTS

From 78 journals of the Journal Citation Report 2013, 43 were selected for this study. The mean IF grew from 1.68 ± 0.97 in 2007 to 2.12 ± 1.05 in 2013, the ES from 0.0113 ± 0.0169 to 0.0114 ± 0.0140, and the AIS from 0.513 ± 0.302 to 0.663 ± 0.359. Differences in the IF, ES, and AIS between journals from the United States versus Europe could be observed. In most cases, the IF, ES, and AIS increased between 2007 and 2013. Strong correlations could be found between IF, AIS, and ES.

CONCLUSIONS

The overall mean IF for obstetrical and gynecological journals increased over the analyzed time period. The IF remains the standard measure to compare scientific journals. It correlates well with two major alternative measures of scientific impact, the ES and especially the AIS. Other measures are evolving and might show superior usage in the future.

Scatter of orthopaedic research: can orthopods stay up-to-date with research?

BACKGROUND

The volume of orthopaedic literature is increasing exponentially, becoming more widely scattered among journals. The rate of increase in orthopaedics is greater than other specialties. We aimed to identify the number of different journals an orthopaedic surgeon would need to read to stay up-to-date with current evidence.

METHOD

We searched PubMed for all orthopaedic-related systematic reviews (SR) and randomized controlled trials (RCT) published in 2011 using MESH (Medical Subject Headings) terms. The search was based on the Australian Orthopaedic Association syllabus of March 2011. The results of the search were exported to EndNote, then Microsoft Excel. We then calculated the least number of journals needed to read 25%, 50% and 100% of the articles. This was done separately for SRs and RCTs.

RESULTS

We found 1400 orthopaedic RCTs spread over 392 journals. Ten journals contained 25% of the articles, 36 journals contained 50% and 114 journals contained 75%. Three hundred journals contained three or fewer RCTs. We found 354 orthopaedic-relevant SRs spread over 152 journals. Six journals contained 25% of the articles, 23 journals contained 50% and 63 journals contained 75%. Ninety-three journals contained only one SR.

CONCLUSION

Our results demonstrate the vast scatter of orthopaedic research. Four orthopaedic RCTs are published every day. To read even 25% of the new RCTs and SRs published in orthopaedics, a surgeon would require a subscription to 13 different journals monthly, a costly and time-consuming endeavour.

Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies

BACKGROUND

National databases are being used with increasing frequency to conduct orthopaedic research. However, there are important differences in these databases, which could result in different answers to similar questions; this important potential limitation pertaining to database research in orthopaedic surgery has not been adequately explored.

QUESTIONS/PURPOSES

The purpose of this study was to explore the interdatabase reliability of two commonly used national databases, the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP), in terms of (1) demographics; (2) comorbidities; and (3) adverse events. In addition, using the NSQIP database, we identified (4) adverse events that had a higher prevalence after rather than before discharge, which has important implications for interpretation of studies conducted in the NIS.

METHODS

A retrospective cohort study of patients undergoing operative stabilization of transcervical and intertrochanteric hip fractures during 2009 to 2011 was performed in the NIS and NSQIP. Totals of 122,712 and 5021 patients were included from the NIS and NSQIP, respectively. Age, sex, fracture type, and lengths of stay were compared. Comorbidities common to both databases were compared in terms of more or less than twofold difference between the two databases. Similar comparisons were made for adverse events. Finally, adverse events that had a greater postdischarge prevalence were identified from the NSQIP database. Tests for statistical difference were thought to be of little value given the large sample size and the resulting fact that statistical differences would have been identified even for small, clinically inconsequential differences resulting from the associated high power. Because it is of greater clinical importance to focus on the magnitude of differences, the databases were compared by absolute differences.

RESULTS

Demographics and hospital lengths of stay were not different between the two databases. In terms of comorbidities, the prevalences of nonmorbid obesity, coagulopathy, and anemia in found in the NSQIP were more than twice those in the NIS; the prevalence of peripheral vascular disease in the NIS was more than twice that in the NSQIP. Four other comorbidities had prevalences that were not different between the two databases. In terms of inpatient adverse events, the frequencies of acute kidney injury and urinary tract infection in the NIS were more than twice those in the NSQIP. Ten other inpatient adverse events had frequencies that were not different between the two databases. Because it does not collect data after patient discharge, it can be implied from the NSQIP data that the NIS does not capture more than ½ of the deaths and surgical site infections occurring during the first 30 postoperative days.

CONCLUSIONS

This study shows that two databases commonly used in orthopaedic research can identify similar populations of operative patients but may generate very different results for specific commonly studied comorbidities and adverse events. The NSQIP identified higher rates of morbid obesity, coagulopathy, and anemia. The NIS identified higher rates of peripheral vascular disease, acute kidney injury, and urinary tract infection.

LEVEL OF EVIDENCE

Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.