Destinations and Methodologic Quality of Surgical Infections Research in Major Surgical Journals

Author(s):
Caitlin Egan; Susan Liu; Philip S Barie

Background:

Surgical infections (SIs) are common and account for high morbidity and cost, thus substantial work is devoted to SI research in several domains including surgical site infection (SSI), skin/soft tissue infection, intraabdominal infection (IAI), sepsis, and antibiotic prophylaxis/therapy. We determined the destination surgical journals, and assessed the quality of studies of SIs published in the surgical literature.

Hypothesis:

We hypothesized that SIs comprise a small proportion of articles published in surveyed surgical journals, and that randomized controlled trials (RCTs) are few.

Methods:

12 international surgical journals were surveyed from January 2013-December 2022. Total numbers of articles, articles on SIs using the SI definition adopted by the Surgical Infection Society, RCTs, citations per article (PubMed,) and the domains of SI research were recorded. RCTs were analyzed for quality by sample size, statistical significance, and fragility index (FI), a measure of robustness of statistically significant study results and size of the measured effect (higher FI indicates more robust data).

Results:

32,060 articles were screened; 1,805 (6%) addressed SIs. The most common domains were SSI (38%) and IAI (32%) (Table 1), and 53% of SI studies were retrospective. Surgical journals published 1,117 RCTs (3%), but only 155 RCTs (1% overall, 14% of RCTs) involved SIs. Ann Surg and Surg Infect published the most SI RCTs (46 and 34), and had the largest mean FI of 6 and 5, respectively (Table 2).  SI RCT sample sizes ranged from 9 to 3213, with the largest mean sample size of 453 in Br J Surg (Table 2).

Conclusions:

Despite the ubiquity of SIs, relevant investigations comprise a small proportion of articles published in surgical journals over the last 10 years, and an even smaller proportion of RCTs. Surg Infect is a major destination for SI-related RCTs. Increased dedication to SI research and rigor of such studies is warranted, particularly for SIs other than SSI.