Changing Trends in Surgical Research: An Analysis of 30 Years of Collaborative Practices

Rapid increases in the number of remote collaborations over the last 20 years are well documented in many scientific disciplines and nonsurgical medical specialties,^1,2 but to our knowledge there are no published studies examining trends in remote collaborations in surgery. Both the scientific research among surgeons³ and the National Institutes of Health funding to academic surgeons relative to their nonsurgical colleagues^4,5 have declined in recent years. Simultaneously, institutions are requiring surgeons to spend increasing amounts of time in the operating room to bolster revenue. Yet, in this era of evidence-based medicine, surgeons require research conducted at the highest level to support their clinical decisions.

Therefore, it is critical to better understand how surgeons are responding to the competing pressures of reduced time and funding for research and increasing demand for clinical evidence. Using results of an analysis of 30 years of publications in 2 preeminent surgery journals, we assessed the trends in collaboration in surgical research.

We selected 2 high-impact general surgery journals, the Annals of Surgery and JAMA Surgery (formerly Archives of Surgery). These monthly, general interest surgery journals publish both basic science and clinical research. The study sample comprised 3 randomly selected issues for each year from each journal for the period from 1984 to 2012. The study goal was to identify the prevalence of remote collaboration among authors of original research studies in the selected issues. Remote collaboration was defined as coauthors with listed institutional affiliations in at least 2 different metropolitan areas. The analysis also tracked trends in sole authorship and changes in local collaboration at an interdepartmental and interinstitutional level. Two-sided Cochrane-Armitage trend tests provided significance levels for changing proportions of collaboration over time.

The study sample included 2218 surgical research articles published between 1984 and 2012. There was a highly significant increase in the number of articles with remote collaboration (P < .001), from 9.59% of articles in 1984 to 39.87% in 2012 (Figure). The number of articles with local interdepartmental and interinstitutional collaborations also increased significantly, from 33.77% to 38.41% of all articles and from 40.43% to 64.84% of those articles not written by remote collaborators (P < .001), mirroring the decreasing number of articles written by 1 author (P < .001).

Our results indicate that “knowledge production” in the field of surgery has changed dramatically over the last 30 years. Little surgical research is being published by individual investigators, but there have been significant increases in the number of surgical research teams comprising investigators from different departments, local institutions, and remote institutions. This may reflect the increased need for multicenter collaborations to enroll adequate numbers of participants and to recruit a more generalizable patient population. It likely also indicates the increasing level of complexity seen in surgical research, which increasingly requires collaboration between surgeons and other experts, such as internists, radiologists, anesthesiologists, biostatisticians, engineers, physicists, and economists, to form interdisciplinary teams.

Despite advances in communication technology, collaboration at a distance remains substantially more difficult than collaboration among researchers who are co-located.⁶ We believe that surgeon-researchers should be commended for rising to the challenge of providing research aligned with the needs and goals of a new culture of evidence-based medicine. Despite the reduced research funding compared with their nonsurgical counterparts, the increased pressure to spend more time in the operating room, and the difficulties of collaborating at a distance, surgeons are finding ways of responding to the increasing need for new knowledge.

Corresponding Author: Jennifer C. Goldsack, MChem, MA, MS, The Value Institute, Christiana Care Health System, 4755 Ogletown-Stanton Rd, Newark, DE 19718 (jgoldsack@christianacare.org).

Published Online: June 18, 2014. doi:10.1001/jamasurg.2014.97.

Author Contributions: Ms Goldsack had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Goldsack.

Critical revision of the manuscript for important intellectual content: Sonnad.

Statistical analysis: Sonnad.

Administrative, technical, or material support: Goldsack.

Study supervision: Sonnad.

Conflict of Interest Disclosures: None reported.