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Background: Citations rates are used to calculate a journal’s impact factor and by academic promotion committees to assess the impact of a researcher’s efforts. In the medical literature, several studies have examined the factors associated with higher citation rates. The results of these studies have varied showing an association with citation rates and numerous study characteristics including study methodology, industry-funding, sample size, and newsworthiness. In the realm of plastic surgery, no study has previously explored what factors are associated with higher citation rates.
Methods: We reviewed all entries in Plastic and Reconstructive Surgery from January 1, 2007 to December 31, 2008. All clinical and basic science articles were analyzed and the following article characteristics were extracted: conflict of interest, sample size, level of evidence, study design, prospectiveness, and number of prior publications by primary author. The number of citations in the plastic surgery literature five years from the time of publication was collected as the outcome variable. A multivariate analysis was performed to determine which variables were associated with higher citations.
Results: A total of 1654 papers were identified of which only 627 fulfilled the inclusion criteria. The majority of the studies were publications in the fields of Breast (14.9%), Reconstructive (25.9%), or Pediatric/Craniofacial (18.1%) surgery. Only 7.8% of the studies disclosed a conflict-of-interest. The average number of citations five years from publication was 12.2. In the multivariate analysis, factors associated with increased rates of citation at 5 years were breast studies (p=0.04), RCTs (p= 0.03), case series (p=0.05), cohort studies (p=0.05), and number of prior publications (p=.01) by the primary author.
Conclusion: The number of previous publications by the primary author, study design, and subspecialty field were found to be associated with higher rates of citation in the plastic surgery literature. Interestingly, conflict of interest, sample size, and level of evidence were not associated with higher citations rates. For investigators who desire to publish studies that will have substantial impact on the field of plastic surgery, our study provides important advice: investigators should aim to conduct randomized controlled trials. Although randomized controlled trials require increased effort and resource utilization, our study provides evidence that they result in significantly more citations offsetting their labor-intensive planning and execution. Furthermore, our study provides evidence that citation rates differ between plastic surgery subspecialties and these differences should be taken into account whenever citation rates are utilized for analytical and comparison purposes. At the editorial level, our results also highlight the importance of using objective metrics to assess the rigorousness of research methodology. The fact that sample size or level of evidence were not associated with higher citation rates (and case series and cohort studies were) suggests that utilizing tools like journal quality checklists may be needed to improve the current quality of plastic surgery research.