Global and Chinese publications in plastic surgery journals between 2010 and 2020: a bibliometric analysis

Introduction

Over the past decade, the quality of articles contributed by plastic surgeons to plastic surgery journals has significantly increased (1). There is considerable variation in the distribution of contributing countries to some prestigious plastic surgery journals (2,3). China has invested much in biomedical research and development (R&D), leading to developments in various surgical specialties in the past years (4-7). Studies have revealed that during the 2000’s, articles from China increased markedly in the field of plastic surgery, yet the publications remained of a lower quality compared to those from other top-ranking countries (7,8). However, a bibliometric analysis has not been conducted recently to elucidate the progress and current state of plastic surgery research.

This study aimed to systematically analyze the publication quantity, quality, and trends in plastic surgery journals from 2010 to 2020, evaluating both global development and Chinese contributions in the field of plastic surgery.

Methods

Search strategy

The Clarivate Analytics 2020 Journal Citation Reports (JCR) was used to identify the major journals within the field of plastic surgery; we also referred to the journals listed in a study by Asaad et al. (9). A total of 35 journals were selected for our bibliometric analysis (Table 1). On 26 February, 2021, we searched the Web of Science to access all articles from these journals that had been published between 1 January, 2010 and 31 December, 2020, using the International Standard Serial Number (ISSN) of the printed editions for the search. The country of origin for each article was determined based on the corresponding author’s affiliation. All original articles from the 8 countries with the most publications, namely, the United States, China, South Korea, Great Britain, Turkey, Germany, Japan, and Italy, were analyzed. Any publications categorized as letters, editorials, corrections, biographical items, news items, book reviews, early access, retractions, or meeting abstracts were excluded.

To assess the quantity and quality of the journals, we extracted the following variables from the Web of Science: country of provenance, number of articles published in the major plastic surgery journals, journal impact factors (IFs), citation counts, whether the article was published in a high-impact journal, the most popular journals in each country studied, and the number of articles supported by funding. We defined “high-impact journals” as the 10 journals with the highest IF according to the 2020 JCR, and the “most popular journals” as the 10 journals with the highest number of articles published between 2010 and 2020.

Statistical analyses

Statistical analyses were performed using the software SPSS 26.0 (IBM Corp., Armonk, NY, USA). A linear regression model was used to describe the changes in the number of articles published annually, and Pearson’s correlation coefficient (r) was calculated. A Kruskal-Wallis test was used to detect differences among the 8 countries. A pairwise rank-sum test was used to compare the publications in China to those of the other 7 countries. A P value <0.05 was considered statistically significant. CiteSpace V (http://cluster.ischool.drexel.edu/~cchen/citespace/) was employed to analyze the references in the articles and build a co-citation network, using the top 50 keywords and 30 cited articles in a 1-year slice. Pathfinder was applied to prune the merged network. Research-topic clusters in the reference co-citation network were identified according to the citing literature’s keywords, and determined using the latent semantic indexing (LSI) and log-likelihood ratio (LLR) algorithms. CiteSpace was also used to analyze the studies that had citation bursts; those with a citation burst in 2019–2020 were regarded as predictive of emerging trends.

Results

The number of articles in the field of plastic surgery

With the predetermined exclusion criteria applied, a total of 55,554 articles were published in the selected 35 plastic surgery journals from 2010 to 2020, inclusive. The original Web of Science records for these articles were exported to Excel (Microsoft, Redmond, WA, USA) for analysis. China contributed 9.48% of these articles, which was less than the United States (32.97%, P=0.003) but greater than South Korea (5.45%, P=0.003), Great Britain (5.27%, P=0.003), Turkey (5.13%, P=0.003), Germany (4.28%, P=0.003), Japan (4.00%, P=0.003), and Italy (3.47%, P=0.003) (Figure 1, Table 2). The frequency of Chinese publications increased over the 11 years, from 318 to 672 (r=0.939, P<0.001), following the trend of publication frequency from the United States (r=0.928, P<0.001), Turkey (r=0.632, P=0.037), and worldwide (r=0.94, P<0.001). In contrast, the number of articles published by Great Britain and Japan decreased (r=−0.706, P=0.015; r=−0.632, P=0.037, respectively). Our analysis revealed no significant trends in the number of publications from South Korea (r=0.559, P=0.076), Germany (r=0.305, P=0.361), or Italy (r=0.094, P=0.784) (Figure 2). As for the proportion of articles from each country, there was an increase in articles from China (r=0.873, P<0.001), and a decrease in articles from Great Britain (r=−0.882, P<0.001), Germany (r=−0.608, P=0.047), Japan (r=−0.891, P<0.001), and Italy (r=−0.736, P=0.010). The proportion of articles from the United States (r=0.221, P=0.513), South Korea (r=0.027, P=0.626), and Turkey (r<0.001, P=0.982) remained relatively stable.

Figure 1 The proportion of articles published in plastic surgery journals from eight countries [2010–2020].

Figure 2 Number of articles published in plastic surgery journals from eight countries [2010–2020].

IF and citation reports

The average IFs were calculated based on data from the 2020 JCR (Table 3). The average IF for articles from China was 1.74, lower than the average IFs for articles from the United States (2.25, P=0.003) and Japan (1.84, P=0.008), comparable to the those for articles from South Korea (1.69, P=0.056), Great Britain (1.74, P=0.689), and Italy (1.66, P=0.056), and higher than those for articles from Turkey (1.40, P=0.003) and Germany (1.69, P=0.014). The total number of citations for Chinese publications was 35,199 (Table 4), which was fewer than the total number of citations for the United States (203,934, P=0.003), but higher than those for the other countries studied. In addition, the average citation count was 6.68 for articles from China, which was markedly lower than the citation counts for articles from the United States (11.13, P=0.003), Great Britain (8.98, P=0.01), Germany (9.75, P=0.003), and Italy (10.36, P=0.003), comparable to those from the other 2 East Asian countries, South Korea (6.85, P=0.05) and Japan (7.85, P=0.859), and higher than those from Turkey (5.02, P=0.003).

Journal analysis

The top 10 plastic surgery journals with the largest number of published articles are shown in Table 5. A total of 21,085 articles were published in these journals from 2010 to 2020, accounting for 37.95% of all articles. The United States published most of these articles (8,500; 40.31%), while China published 1,641 articles in these journals, making it the second-largest contributor. Table 6 lists the 10 most popular plastic surgery journals for authors from the 8 countries analyzed. The Journal of Craniofacial Surgery was the most popular journal in China, South Korea, Turkey, Japan, and Italy, while in the United States, Plastic and Reconstructive Surgery was the most popular journal. The 3 most popular journals in China also included the Annals of Plastic Surgery and the International Journal of Oral and Maxillofacial Surgery, publishing 547 and 337 articles, respectively, from 2010 to 2020. The British Journal of Oral and Maxillofacial Surgery was the most popular journal in Great Britain, and the Journal of Cranio-maxillofacial Surgery was the most popular in Germany; both journals specialize in craniofacial surgery.

Funding support

The numbers and percentages of articles supported by funding are listed in Table 7. China had the highest funding rates from 2010 to 2020, with 45.3% of articles supported by funding. Of these, 1,134 were funded by the National Natural Science Foundation of China (NSFC). South Korea ranked second, with 31.69% of articles supported by funding, followed by the United States (24.07%), Japan (24.03%), Germany (15.77%), Great Britain (15.12%), Turkey (8.73%), and Italy (6.17%).

Analysis of references

Clusters of co-cited references in global and Chinese articles were generated. The keywords are listed in Tables 8,9 for a more comprehensive summary of the research topics. The most recent global clusters included Clusters #2, #8, and #10 with an average publication year of 2016. By taking a closer look at the most recent clusters worldwide (Clusters #2, #8, and #9), we could infer that fat grafting and breast implant-associated anaplastic large cell lymphoma were the predominant worldwide focuses of recent research. In China, the most recent clusters were Clusters #5 and #9, indicating novel fat-grafting techniques, hypertrophic scars and keloids, and computer-aided craniomaxillofacial surgery were focuses of study in China more recently.

References in global and Chinese articles with the strongest citation bursts in 2019 and 2020 are shown in Tables 10,11 (10-28). We concluded that the topics of these articles revealed emerging trends from another aspect. Cellular events and techniques of fat grafting, and mortality from gluteal lipo-injection were reported upon (16-19), suggesting that fat grafting may be an emerging research trend worldwide. There were 3 studies related to implant-based breast reconstruction or breast augmentation, which could be a global emerging trend (14,15,20). Medication-related osteonecrosis of the jaw (13) and blindness after filler injection (12) could also be emerging study trends. According to the references in Chinese articles, cellular events, clinical applications, outcomes, and new products for fat grafting were studied (17,26-28). Therefore, fat grafting is an emerging research trend in China. In the field of head and neck reconstruction, computer-aided surgery and the use of anterolateral thigh flap are expected to become research trends in China (21,22,25). In addition, blindness after filler injections, extracellular matrix/stromal vascular fraction gel for stem cell therapy (23), and the wide-awake local anesthesia no tourniquet (WALANT) method in hand surgery (24) were shown to be emerging trends as well.

Discussion

There has been tremendous growth in the volume of plastic surgery research globally and in China. Though analyses of Chinese contributions to various surgical specialties, such as orthopedics (6), otorhinolaryngology (5), obstetrics, and gynecology (4), have been performed previously, articles detailing Chinese achievements in plastic surgery are almost a decade old (7,8). Zhang et al. (7) studied plastic surgery publications from 2000 to 2009, demonstrating a substantial increase in Chinese contributions to the 6 selected high-impact journals. Their second literature survey revealed Chinese contributions in the same plastic surgery journals from 2005 to 2009 (8). Our bibliometric study included a more comprehensive journal list and traced the trends in plastic surgery publications between 2010 and 2020. Such findings are indicators of plastic surgery research trends and are useful for future funding allocations.

The United States came first in both the number and percentage share of publications. The past 11 years have witnessed continuous annual growth in the number of plastic surgery articles from China. The trend is consistent with a previous study of publications from 2000 to 2009 (7), which reflected the rapid development of plastic surgery. From 2010 to 2020, an increasing number of articles from China were supported by funding from various sources, and the rate has increased by 50% since 2019. These results suggest that China is supporting plastic surgery academia by increasing funding expenditure. In addition, the rapid growth of the Chinese GDP could result in more surgical procedures, especially cosmetic, being performed, resulting in a large and accessible research cohort (29). A promising future trend of more funding awaits, encouraging more Chinese surgeons to apply themselves to this field.

We calculated journal IFs by dividing the number of citations in 2019 for articles published in 2017 and 2018 by the number of substantive articles and reviews published in 2017 and 2018 (30). Although we only used data from 2 years to calculate the IFs, we presumed that they were consistent with a 5-year IF (9) and positively correlated with a 50-year IF (31), thus reflecting the quality of the journals over a long period.

The average IF of Chinese articles was at the forefront worldwide, indicating that Chinese articles have been published in high-quality journals. However, we also noticed a considerable gap between the average IF for China, the United States, and Japan. The rank of total citations was similar to that of the cumulative IFs, with China ranking second to the United States. However, articles from China had a lower citation count when compared to the United States, Great Britain, Japan, and Italy. Furthermore, China contributed less than the United States to the 10 journals with the highest IFs. It was discouraging to note that the quality of articles from China lagged behind in terms of quantity compared to developed countries.

We noticed discrepancies between the average IFs and citation counts. There are several possible explanations for this. First, reviews tend to have higher citation counts than original articles, resulting in citation count figures for an individual article that are higher than the corresponding journal’s IF. Secondly, the difference could also be attributed to citation skew. Asaad et al. (32) assessed the citation distribution of articles published in 33 plastic surgery journals between 2016 and 2017. Their findings demonstrated that 66% of articles had a citation count lower than their journal’s IF, and that only 12.6% of articles contributed to 50% of citations.

The Journal of Craniofacial Surgery was the most popular journal among the Asian countries studied, namely, China, Turkey, South Korea, and Japan. According to a study by Liechty et al. (2), Asia was the main contributor to this journal, producing 55.8% of its total publication in the 2010s. In addition, we noted 7 of the analyzed countries published most of their articles in journals specializing in craniofacial surgery. In comprehensive plastic surgery journals, articles discussing head and neck reconstruction accounted for the highest proportion of publications in 2006 to 2016 (33). These results suggest that craniomaxillofacial surgery has been at the forefront of plastic surgery developments.

The intellectual integrity was identified via the co-citation network. We listed major clusters according to their number of members. The most recent clusters were indicative of the emerging trends.

These emerging trends were also predicted using the references with the strongest citation bursts in 2019 and 2020. Fat grafting and blindness after filler injection were shown to be emerging trends worldwide, including in China. Globally, implant-based breast surgery and osteonecrosis of the jaw are also expected to become research trends. In addition, research trends in China included computer-aided maxillofacial surgery, anterolateral thigh flap in head and neck reconstruction, extracellular matrix/stromal vascular fraction gel for stem cell therapy, and WALANT hand surgery.

The current study performed bibliometric analysis of 55,554 articles in 35 plastic surgery journals; however, the study had several limitations. Interdisciplinary research published in journals not specializing in plastic surgery, for example, the study of bone development and repair mechanisms published in Nature Reviews Molecular Cell Biology (34), was not analyzed. Since there is not a ‘plastic surgery’ category in the SCIE database, our study might not have included all the plastic surgery journals. However, with a total of 35 plastic surgery journals analyzed in our study, it is not likely the publication trends would be significantly different.

Conclusions

Our analysis demonstrated the rapid expansion and trends of plastic surgery research worldwide and in China. While the United States was the most productive country in terms of research, China contributed a considerable number of articles to the field, many of which were supported by funding. The quality of the articles from China did not equal their quantity. This study may indicate possible research trends in the future and promote further support for plastic surgeons who are pursuing careers in research.

Acknowledgments

Funding: This work was supported by Clinical and Translational Medicine Research Fund Project of Chinese Academy of Medical Sciences (No. 2020-I2M-C&T-A-018).

Footnote

Peer Review File: Available at https://atm.amegroups.com/article/view/10.21037/atm-22-137/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-137/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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