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EUGENE GARFIELDINSTITUTE FOR SCIENTIFIC INFORMATION*3501 MARKET ST, PHILADELPHIA, PA 191W

Jourd Citation Stdfes. 45.Smgery Joumds: Another Operation In

Citatfon Adysfs

Number 21

About five years ago, we discussedhow patients should shop for a surgeon. 1But at the time, it occurred to me thatthe surgeon might well ask, “How do youshop for a journal?” Since then, we’veanalyzed journals in many fields-toonumerous to list them all here. More re-cently, we examined nursing jouruals.zBut some other medically oriented fieldsthat we have examined through the Sci-ence Citation Inde-@ (SCP ) and SocialSciences Citation Znde@ (SSCF’ ), in-clude neuroscience,J dental science,4pediatrics,s and pathology.b Most ofthese essays have also discussed themost-cited articles from these journals.In the tables that follow, we’ve providedconsiderable data for the field of sur-gery. In addition, we’ve added severalmaps showing some of the major re-search efforts in this branch of biomedi-cine. These maps will be dkcussed later.

Hfstory of Surgery

The word “surgery” is derived fromthe Greek words their meaning “hand”and ourgos for “working.’’8.8 Today, sur-gery is de~med as that part of medicinethat treats injuries, deformities, dis-eases, and other disorders by manualoperations or with instrumental appli-ances.

In ancient times, surgery was prac-ticed in China, Egypt, Greece, and In-dia.g The Hindus (500 BC) practicedmany of the basic surgical techniques

May 27, 1985

that surgeons use today. They were alsothe fwst to perform plastic andreconstructive surgery. During the timeof Hippocrates (460-370 BC), surgeonswere skilled in the treatment of fracturesand wounds. They knew that patientswith broken bones should be kept im-mobile and that wounds should becleaned with boiled water or alcohol,and then kept dry. These principles arestill considered basic to the practice ofthe surgery of trauma, which deals withthe immetlate treatment of acutely in-jured patients. Unfortunately, the quali-ty of surgery began to gradually declineafter the fmt century AD. 10 By thetwelfth century, it had become a menialtask performed by craftsmen who knewhow to let, or intentionally release,blood from the body.s,lo Surgery wasoften practiced by barbers who had beentrained to bleed and shave monks. 10

The earliest surgical guilds were estab-lished by the few formally trained sur-geons. They wanted to control the quali-ty of the surgery performed by barber-surgeons. The Colh?ge de St. C6me wasfounded in Paris in 1210.10 The Com-pany of Barber Surgeons of London wasformed in 1540. The latter guild lastedfor more than 200 years. In fact, it wasthe precursor of the present Royal Col-lege of Surgeons of England,g of whichthe Anna/s are stifl published regularly.

“Modem” surgery began in 1846 whenether was used in surgical anesthesia atMassachusetts General Hospital, Bos-

197

ton. Louis Pasteur’s discovery that mi-croorganisms caused infection, andJoseph Lister’s realization that antisep-tics inhibited the growth of microorgan-isms in surgical wounds, revolutionizedsurgical practice, and enhanced itsdevelopment into a scientflc dkcipliie.Other important medical advances thataffected surgery include the invention ofX rays (1895); the identtilcation of thedifferent blood types (1900); and the useof intravenous infusions to replace bodyfluids (1930s).9,10 (Seventeenth-centuryphysicians were actually the first to useintravenous infusions, but it did not be-come a part of standard practice untilthe early twentieth century.) The in-troduction of antibiotics (1940s) and thedevelopment of microsurgery (1950s)are two medical breakthroughs made inthe latter half of the 1900s.9

Today, surgical methods continue toimprove with the development of newmedical technologies. For example, ul-trasound, or sound waves or vibrationsof a frequency higher than the humanear can detect, can be used as a diagnos-tic tool before surgery to detect abnor-malities in tissues or organs. These high-pitched waves create characteristicechoes when they are reflected off tissueboundaries of varying densities.s!l 1Theechoes then are transformed into anelectronic picture that is displayed on avideo monitor. Ultrasonic vibrations areafso used to fragment or break apart tu-mors during surgery.lz Figure 1 is a clus-ter map of research fronts that we haveidenttiled for ultrasonography and com-puted tomography (CT). I’ll have moreto say about tomography later in thwessay.

Laser surgery, another new tech-nique, uses single-wavelength beams oflight energy to destroy tissue or cauter-ize bleeding vessels during surgery. La-sers are highly accurate and intrinsicallysterile. And, since laser beams coagulateblood, laser surgery is nearly blood-

less. 13 Ultrasonography and laser sur-gery are but two of the dozens of topicscovered under the umbrella of biomedi-cal engineering. I discussed this field inthe Alza Lecture that I gave on April 24,in Anaheim, California. This lecture issponsored each year by the B~omedicalEngineering Society at the annual meet-ing of the Federation of AmericanSocieties for Experimental Biology(FASEB).14

In the United States, there are now 10surgical specialty areas within the 31 rec-ognized medical specialties. These 10surgical areas are plastic, orthopedic,obstetric and gynecologic, ophthamalic,colon and rectal, urologic, otolaryngo-logic, necrologic, thoracic, and general.Within these specialties, there are manysmaller, more specific subspecialties.g

Surgery Journals

Many of the 10 areas of surgery listedabove are covered by the 27 “core” jour-nals listed in Table 1. Subspecialties,such as trauma and pediatric surgery,are also represented. Of course, this listdoes not include every surgery journalpublished today. We selected the sur-gery core used in thk study after careful-ly examining the citations received andreferences given out by surgery journalsindexed in the Journal Cita tion Reportsm(.TCRTM), volumes 15 and 16 of the 1983SCI.

The oldest journal in Table 1 is ActsChirurgica Scandinavia, which was fiistpublished in 1869. Originally titled Nor-diskt Medicinskt Archiv, itchanged toits current title in 1919. However, therewas no break in the sequence of its vol-ume numbers. Several additional jour-nals in Table 1 also had changes thatwere in title only. And other journalswere started as new publications aftersuperseding older journals that hadceased publishing. A eta ChirurgicaScandinavia is one of three surgery

198

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journals in the list that began publishingin the 19th century. The other two arethe Annals of Surgery (1885) and theAmen”can Journal of Surgery (1891).These latter two journals are publishedin the US, while A eta Chirurgica Scandi-na vita is published in Sweden. US pub-lishers, incidentally, account for 20 ofthe journals in this study, although sev-eral of these journals are considered in-ternational publications. Three journalsare published in the UK. Austria, Can-ada, France, and Sweden each accountfor one.

Twenty-four of the core journals arepublished exclusively in English, whileone, Neuro-Chirurgie, is publiihed inFrench. The Canadian Journal of Sur-gery is bilingual (French and English),while A eta Neurochirwgica accepts pa-pers in English, French, and German.

In this study, we treat the group of 27“core” surge~ journals as if they were asingle “Macro Journal of Surgery. ” Thk

Table 1: Core surgery journals indexed in the SCFand the year that each began publication.

Acts Chirurgica Scandkavica—1869Acts Neurochwurgica— 1950American Journal of Surgery-1891American Surgeon—1 935Annals of Plestic Surgery-1978Annals of Surgery-1885Annals of the Royal College of Surgeons of

EngJand-1947AnnaJs of Thoracic Surgery— 1965Archives of Surgery— 1920British Joumaf of Plastic Surgery-1948British Journal of Surgery-1913Canadian Journal of Surge~—1957Clinics in Plastic Surgery-1974Diseases of the Colon and Rectum—1958Joumaf of Neurosurgery-1944Journal of Pediatric Surgery-1966JoumaJ of Surgical Research— 1%1Journal of Thoracic and Cardiovascular

Surgery-1 931Journal of Treuma-1%1Neuro-Chimrgie- 1955Neurosurgery-1977Plastic and Reconstructive Surgery-1946Surgety-1937Surgery, Gynecology & Obstetrics-1905Surgical Clinics of North America-19Z0Surgical Neurology—1973World Journal of Surgery-1977

199

is a convention that we have used in pre-vious analyses. We have determined andranked the journals cited by this macrojournal, as well as the journals that citeit.

Journal stdstfcs

In 1983, the 27 “core” surgery journalspublished 4,900 articles. Thw representsslightly over 1 percent of the 451,000 re-search articles covered in the 1983 JCR.These 27 journals included over 94,500references in 1983, about 1 percent ofthe 8,000,000 references processed tocreate the JCR that year. In other words,the average 1983 surgical article citedapproximately 20 references, a few morethan the 18 for the average JCR article.

Articles from the 27 surgery journalsreceived 91,000 citations in 1983. This isalso 1 percent of the total JCR citations.Six journals account for 55 percent—Annals of Sutgery (11,300); Surgery(8,5C0); Journal of Neuroswgery (7,650);Journal of Thomcic and CardiovascularSurgery (7,600); Surgery, Gynecology &Obstetrics (7,600); and the Amen”canJournal of Surgery (7,300). These dataand the data for 44 other journals areprovided in Table 2. They are ranked bythe number of citations that they re-ceived from the core that year. The tablealso provides total citations; self-cita-tions; 1983 impact factor and immediacyindex (explained later); and number of1983 source items for the 50 journals.

The journals in Table 2 received over53,000 citations from the 27 core jour-nals. This accounts for 56 percent of thereferences given out by the core in 1983.Twenty-two of the 50 journals are them-selves core surgery journals. They areindicated in the table by asterisks.Thirty-eight percent of the citations re-ceived by these 22 core joumafs werefrom other core surgery journals. How-ever, the figure for Plastic and Recon-structive Surgery is over 50 percent.

Annals of Swgery is the most-citedcore journal. But it is also highest in imp-act (2.9). However, the Journal ofThomcic and Cardiovascular Surgeryranks fifth in citations, but second in im-pact (2.4). Surgery ranks third (2.3) inimpact and citations. And the Journalof Neurosurgery ranks fourth in impact(1.8) but second in cites. Archives ofSu~ery ranks ftith in impact (1.7), whflethe median impact for core surgery jour-nals is 1.0. (The median is calculated byranking the journrds by impact factorand then determining which value is inthe middle of the list, with an equal num-ber of values both above and below it.)The median impact for the 27 surgeryjournals in this list is slightly higher thanthe median for all SCZ journals in1983-0.6. Part of thw can be attributedto the higher number of references in theaverage surgery paper.

In Table 3, we provide data for the 10highest impact surge~ journals. In the1983 JCR, impact is calculated by divid-ing the number of 1983 citations to 1981and 1982 articles by the number of arti-cles published by that journal in 1981and 1982. But in Table 3, we have alsocalculated 1983 impact factors using fivedifferent two-year bases for each jour-nal. Thw illustrates the time lag in the lit-erature of some disciplines. In surgery,unlike the “hotter” fields of biomedicalresearch, citations peak a little later.The highest impact occurs when 1980-1981 is used as the base period. AndSurgery and Annals of Surgery peak inimpact in the 1979-1980 period. Annalsof Thomcic Swgery and the Journal ofNeurosurgery peak in 1978-1979.

Table 4 liits the 50 journals that mostfrequently cited the macro journal ofsurgery in 1983. Although they representjust 4 percent of the 1,3tN journals thatcited the core, these 50 journals accountfor 52 percent of the citations receivedby the core. Twenty-six of these journals(indicated by asterisks in Table 4) are

200

Table 21 The 50 jounrals most cited by core surgery journals in 1983. An asterisk indkates a core journal.A= citations from cme journals. B =citations from aU joumafs. C= self-citations. D=percent of totalcitations that are core journal citations (A/B). E= percent of total citations that are self-citations (srdf-cited rate, C/B). F =percent of core journal citations that are seff-citations (C/A), G = 1983 impact fac-tor. H = 1983 inrmedktcy index, I= 1983 source items.

ABC DEFG H1

3986 11,303 504 35.3 4,5 12.6 2.90 .31 2143467 7640 1518 45.4 19.9 43.8 1.80 .29 3323175 8510 531 37.3 6.2 16.7 2.28 .23 2922673 7290 274 36.7 3.8 10,3 1.65 .20 2252579 7615 1087 33.9 14.3 42,2 2.41 .34 255

“Ann, Surg.“J. Neurosurg.“Surgery‘Arch. Surg.‘J. Thomc. Cardlovasc. Surg.“Amer. J. Surg.“Surg. Gynecol. Obstet.“Plast. Reconstr. Surg.“Brit. J. .%rg.

N. Engl. J. Med.LancetCancerCirculation

●Ann. Thorac. Surg.JAMA-J, Am. Med. Assn.GsstroenterologyBrit, Med. J.Radiology

“J, TraumaAmer. J, Roentgenol.

“Surg. Neurol.Amer. J. Cardlol.

“J. Pediat. Surg.“Acts Chir. Stand.Amer. J, Fhysiol.

●Neurosurgery“Surg. Clin. N. Amer.●J. Surg. Res.“Dis, Colon Rectum

Surg. ForumJ. Bone Joint Sutg.—Amer. Vol.Ann. Intern. Med.

‘Brit, J. Plast. Surg.GutJ. Neurol. Neurosurg. Psychiat.

●Acts Neurrrchir.StrokeJ. Clin. Invest.J. Urol.NeurologyCUC. Res.Amer. J. Med.

“Amer. Surg.Arch. Neurol.

“World J. SurgeryAmer. Heart J.Cancer Res.J, PedLrt.ChestAnesthesiology

2571 73362377 75782256 40622074 58161732 56,8411605 59,4221509 29,S391492 33,6321295 32501229 24,2391112 19,6421015 30,782IOU5 16,109978 2236753 10,577703 1412686 19,969679 2061656 2493637 34,956637 1335616 1795569 1886566 1337516 1404512 6313489 21,128477 950472 6%1465 47’75452 939447 3061434 38,5fuJ405 11,572402 8359398 !7,487387 17,351374 993362 6702346 845315 10,098310 31,754303 14,563282 6204279 7357

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201

Table 31 The 1983 impact factors of selected corejournals using dtiferent two-year bases. Jourrudsare listed in alphabetic order. A= 1981-1982.B=198&1981. C=1979-1980. D=1978-1979.E= 1977-1978.

ABCDE

Amer. J. Surg.Ann. Surg.Ann. Thorac.

Surg.Arch. Surg.Brit. J, Surg.J. Neurosurg.J. Thorac.

Cardiovasc,Surg.

Surg. Gynecol.Obstet.

SurgeryWorld J.

Surgery

1.29 1.71 1.71 1.66 1.442.’YJ 3.71 3.78 3.29 3.16

1,24 1.78 1.7S 1,92 1.831.65 1.98 1.98 1.84 1.701.58 1.83 1,77 1.72 1.621.80 1,93 1.99 2.19 2,11

2.41 3.20 2.97 2.54 2.28

1.48 1,70 1.62 1.55 1.372,28 2.81 3.23 2.10 2.39

1.40 2.23 ---- ---- ----

core surgery journals. Only Neuro-Chi-rurgie does not appear. Had we extend-ed the table, it would have ranked 61st,with 348 citations to the core.

The 26 core journals in Table 4 pro-vided over 93,000 references in 1983.Only 37 percent of these were to corejournals. The remainder were to jour-nals such as the New England Journa[ ofMedicine, Lancet, Cancer, Circulation,the Journal of the American Medical As-sociation, and the British Journal ofMedicine. This is clearly seen in Table 2,where these journals rank higher thanmost surgery journals. The percentagesin column D of Table 4 are sometimesreferred to as specialty factors. For ex-ample, the American Surgeon cites thecore literature 49 percent of the time,thereby having the highest citing special-ty rate.

Just as the age of citations affects im-pact, we can learn a lot by looking at ajournal’s half-life. This is the median ageof its cited and citi”ng literature. Table 5lists the cited and citing half-lives for 26of the 27 core surgery joumak. (A nnal.sof Plastic Surgery is not included be-cause we only began to cover it in the

SCI recently.) Cited half-life is the med]-an age of the articles from each journalthat were cited in 1983. The averagecited half-lie for surgery journals is 7.3years. That is, on the average, half of the1983 citations to core surgery journalswere to articles they published over thepast seven years. This number is higherthan that in other fields that we havestudied, For example, anthropology hasan average cited half-life of 3.1, whilenursing has a haff-life of 4.6, and astro-sciences, 5.4 years. Neurosurgery hasthe shortest cited half-life-3.3 years,while the number for several joumals iggreater than 10 years. For Acts Chirur-gica Scandinavia, more than 50 percentof the 1983 citations it received were toarticles it published prior to 1973.

Citing half-liie is the median age of theliterature cited by a journal. It gives usan idea of the age of the literature thateach journal cites. In 1983, the averageciti”nghalf-Iife for a core surgery journalwas 7.7 years. The Jouma[ of Thoracic

and Cardio vasctdar Surgery had theshortest citing half-liie-6.2 years. Halfof the references it gave out in 1983 wereto articles published from 1978 to 1983.

The immediacy index of a journalmeasures how often its articles werecited in the same year that they werepublished. In 1983, Annals of the RoyalCollege of Surgeons of England rankedfirst among the 27 core surgery journalsin immediacy—O.44. Not surprisingly,this journal publishes a sign~lcant num-ber of letters in each issue, as does theBritish Journal of Surgery (0.40), whichis ranked second in immediacy. They arefollowed by the Journal of Thomcic andCardiovascu[arSu rgery (0.34); Annals ofSurgery (0.31); and Journal of Neurosur-gery (0.29). Three of these (Journal ofThoracic and Cardiovascular Surgery,Annals of Surgery, and Journal ofNeurostqery) are also among the topfive journals when ranked by impact fac-

202

Table 4: The 50 journals that most frequently cited core surgery journals in 1983. An asterisk(•) indicatesa core journal. A= citations to core journals. B= citations to aJJjournals. C= seIf-citations. D= percentof total citations that are core journal citations (A/B). E =percent of total citations that are seff-citations

(self-citing rate, C/B). F= percent of core journal citations that are seJf-citations (C/A). G= 1983 impactfactor. H= 1983 immediacy index. I= 1983 source items,

“Amer. J. Surg.“J. Neurosurg.“Surgery“J. Thomc. Cardlovasc. Surg,“Ann. Surg.“Arch. Surg.“Ann. Thorac. Surg.“Neurosurgery‘Brit. J. Sur&●Plast. Reconstr. Surg.“Surg. Gynecol. Obstet.“Surg. Clin. N. Amer.●J. TrsumaCancer

“Amer. Surgeon“Dis. Colon Rectum●Surg. Neurol.“Acts Cbir. Stand.“J. Pediat. Surg.●World J. Surgery“Ann. Plastic Surg.Radiology

“J. Surg. Res.‘Can. J. Sung.N. Engl. 1. Med.Clin. Orthop. Related Res.Amer. J. Roentgerrol.GastroenterologyJ. Urol.CirculationJ. Chir.—ParisSouthern Med. J.Langenbecks Arch. Chk.

“Clii. Plast. Surg.“Ann. Roy, COJJ.Surg. Engl.Tborec. Cardiovssc. Surg.

“Acts Neumchir.ChimrgieBrit, Med. J,J. Surg. Oncol.ChestStrokeAmer. J. Card]ol.L3ncetTransplant. Fmc.Sem. Hop. hisAmer. J. Gastroenterol.

“Brit. 1. Plast. Surg.Crit. Care Med.Schweis. Med. Wochenachr.

ABC DEFGH I

2492 5685 406 34,8 7.1 16.3 1.29 .17 3522358 8170 1518 28.9 18,6 64.4 1.80 .29 3322265 6177 531 36.7 8.6 23.4 2.28 .23 2922083 5331 1087 39.3 20.5 52.2 2.41 .34 2551999188017581719159015581450129912651233111911131071IW49749178317627197096356215805655645635S8555552547540535527498476474445440433433430419405‘KM403399

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45 37.4 1.3 3.5 1.19 .06379 38.6 11.6 30.0 .85 .11

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203

Table 5: The 1983 SCP cited sud citing half-lives o]core surgery joumaJs liited in alphabetic orderJournals with no listing either received or gawout less than 10Ucitations in 1983. A = cited htdflife. B= citing h.df-liie.

A>10.0

5.38.48,8. . .

7.89.05.99.8

>10.08.45.85.16.38.47.46,26.67.09.03.37.28.1

>10.05.07.73.7

B8.28.17.08.6.. .

8.27.07.26,79.67,27.27.58.67.88.87.16.27.89.47.77,96.97.89.16.76.9

Acts Chk. Stand,Acts Neurochii.Amer. J. Surg.Amer. Surg.Ann, Plsstic Surg.Ann. Roy. COU. Surg. Engl.Ann. Surg.Ann. Thorac. Surg.Arch, Surg.Brit. J. Plast. Surg.Brit. J. Surg.Can. J. Surg.Clin. PJsst. Surg,Dis, Colon Rectum1. Neurosurg.J. Pediat. Surg.J. Surg. Res.J, Thorac, Cardiovasc, Surg.J. TraumaNcuru-ChiirgieNeurosurgeryPlsst. Reconstr, Surg.Surg. Clin, N. Amer.Surg. Gynecol. Obstet.Surg, Neurcd.SurgeryWorld J. Surgery

tor. The median 1983 immediacy indexfor the macro journal of surgery is 0.13,compared to 0.18 for afl SCZjournals in-cluded in the 1983 JCR.

Recently, we referred to an article-by-article analysis that we conducted forcertain journals. IS In these audits, weexamine the year-by-year performanceof each article over six or more years.We are also able to examine the varia-tions in clifferent types of publisheditems. Not alf “articles” are equal. InTable 6, we have provided data for thetwo most-cited surgery joumals—An -nals of Surgery and Swgery. We used1978 as the base year. Using six years ofthe SCI file (1978-1983), we identified240 items for Annafs of Surgery. Ofthese, 168 were research articles. Sixty-seven items were classf]ed as “proceed-ings.” Many of these items are actuallythe fulf texts of articles presented at con-

ferences, annual meetings, and so on, incontrast to meetings abstracts, whichwould be coded as such. Only five itemswere editorials, reviews, and othermiscellaneous works. The 1978 articlesfrom Annals of Surgery received over 50percent of the journal’s 1978-1983 cita-tions—2,003. Procee&mgs papers re-ceived 1,491.

The most important data are the six-year impact values (columns E and F).Whfie alf items in Annals of Surgery andSwgery are cited an average of 14.6 and12.3 times, respectively, there seems tobe a much higher average for proceed-ings papers (22.3 and 15.3). This demon-strates the wide variability within jour-nals for the many different types of itemspublished. In some cases, the averagingmay work to the advantage or disadvan-tage of a particular journal. The largeletters columns in some medical journalslike the New Eng[and Journal of Medi-

Table 6: Article-by-article analysis of 1978 sourceitems pubUsbed by Annals of Surgery rmdSurgery. A=number published in 1978. B=number cited fmm 197&1983. C=percentcitedness (B/A). D= number of 197&1983 cita-tions. E= cited impact (D/B). F= totrd impact(D/A).

Anm!s of Sqesy

ArticlesJwtorisfs

LettersNotesReviewsProceedingsAU OthersTOTAL

ArticlesEditorialsLettersNotesReviewsProceedingsAU OthersTOTAL

ABCD168 151 89.9 m

100.00000.0000 0.0 031 33.3 9

67 64 95.5 149110 0.0 0

240 216 90.0 3503

EF13.3 11.90.0 0.00.0 0.00.0 0.09.0 3.0

23.3 22.30.0 0.0

16.2 14.6

A103

111895

1152

263

Surgery

BCDEF99 %.1 1251 12.6 12.1

8 72,7 36 4.5 3.34 22.2 7 1.8 0.49 100.0 41 4.6 4.65 1(13.O 140 28.0 2E.O

115 100.o 1764 15.3 15.30 0.0 0 0.0 0.0

240 91.3 3239 13.5 12.3

204

TsMe 71 The moat-cited article from each core surgery journal cited at least 50 times in the SCP, 1955-19S3, in alphabetic order by fiit author. A= 1955- 19S3 citations. The 1984 citations appear in parrm-theses. B= blbliogmpfric data. C= total number of papers from that journal cited at least 50 times. Ansateriak (”) before a paper indkates that it was the subject of a Cito tion Chrs~icTM commentary. The issue,year, and e&tion of Cunsvrf Conrenr@ in which the commentary appeared follow the bibliographicref ererrce.

A375 (4)

se (9)

294 (lo)

243 (23)

143 (7)

229 (lo)

3m (17)

14 (5)

54ff (24)

1s7 (7)

444 (7)

103 (14)

239 (o)

% (5)

128 (1)

& (1)

as (3)

303 (8)

m9 (15)

142 (1)

85 (19)201 (43)

132 (14)

701 (26)

BAOfson P R. Reflux esophagitis, slidirrg hiatal hernia, and (he anatomy of repair.SurX. Gynecof. Obstet. 92:419-31, 1951.

Andm-aert D, Hostrop H & Anwfmp E. The Aarhus county vagotomy trial. 11, Aninterim report on reduction in acid secretion and ulcer raaurrence rate folfowingpsrietal ceff vagotomy and selective gastric vagotomy. World.! Surgery 2:91 -llX),1978.

“Aslrbaugh D G, Petty T I+ Blgelow D B & Hmrls T M. Continuous positive-pressurebreathing (CPPB) in adult respiratory distress symfrome. 1 Thoroc. Grrdio WC. Surg,57:31-41, 1%9. (44/T3/cP)

Bakamjhrn V Y. A two-stage mettd for pharyngoasophageal reconstruction with aprknary pectoral skim ffap. Pfart. Reconrtr. Surg. 36:173-84, 1%5.

“Barlow B, Sarmdff T V, Ilefrd W C, PM 1, Bfane W A & Sddffnger I N. Anexperimental study of acute neonatal enterocolitis-the importance of breast mifk.J. Pedtit. Surg. 9:587-95, 1974. (52/i31/CP)

Botterelf E H, Lougheed W M, Scott 1 W & Vmrdewater S L. Hypothermia, andinterruption of carotid, or carotid and vertebral circulation, in the surgical manage-ment of intmcranial aneurysms. /. IVfruromog. 13:1-42, 1956.

Brfcker E M. Bladder substitution after pelvic evisceration. Swg. Clin. N. Amer.3Ch1511-21, 19$3.

Capper WM. Factors in the pathogenesis of gastric ulcer.Ann. Roy. Colt. Surg. EngL 40:21-35, 1967.

Doefrfck S 1, WUmore D W, Vms H M & Rhrtads J E. Long-term total parenteralnutrition with growth, development, and positive nitrogen balance. Surgery64:134-42, 196s.

“Fmwloro R G. .%phenous vein autograft replacement of severe segmental coronaryartery occlusion. Operative tecbrdque. Arm. Thomc. Surg. 5:334-9, 1968. (32/81/CP)

FJene C, K8kker V V & Clarke M B. The detection of venous thrombmii of the legsusing 1251-labeffed fibrinogen. Brit. J. Surg. 55:742-7, 196S.

French B N & Dublln A B. The value of computerized tomography in themanagement of KXMconsecutive heed injuries. Surg. Neuroi. 7171-83, 1977.

Kakkar V. The diagnosis of deep vein Urrombeaii using the l“I fibrinogen test.Arch. Surg. t04:152-9, 1972.

Mod IF, Warrimt W G & Waridfng W L Responses of the gastrnesophagealjunctional zone to increases in abdominal pressnre. Can. J. Surg. 932-8, 1966.

Lfndberg R B, Monerkd I A, %vftser W E, Order S E & Mfffa W. Tire successfulcontroI of bum wound sepsis. J. Trauma 5:601-16, 1%5.

Ludeeke D, Kmrtsky R, Saeger W & Schrader D. Selective removal of hypersecretingpituitary adenomas? Acts Neurochir. 352?-42, 1976.

IbJoratz W H, Rhode C M & Shepherd M H. Prevention of prdmonary embofi bypardaf occlnsion of the inferior vena cava. Amer. Surg. 25:617-26, 1959.

“NiLwwm1 M & Olow B. Pibrinolysis induced by streptokmase in man.Acts Chir. Stand. 123247-66, 1%2. (5/80/CP)

“Paytm J M & DeWfnd L T. Surgicnl treatment of obesity. Amer. Z Surg.118141-7, 1%9. (48/81/CP)

Petersen N C, Bodenham D C & Lfoyd O C. Malignant mefanomzs of the akin.Part I. Btit. J. Plwt. Surg. 1549-94, 1%2.

Reefue R. Kindfirrg: the first decade. Neurosurgery 3234-52, 1978.Strmb N C, Martd R D, Brfgfuam K L+ Demfiag R, Erdntamr A I & Woofverton W C.Preparation of chronic lung lymph fmtulas in sheep. 1 Surg, Res. 19315-20, 1975.

Trsrcot 1, Desprea I.P & St. Pierre F. Malignant tumorz of the central nervous systemassociated with famifial polyposis of the colon. Dis. Colon Rectum 2:465-8, 1959.

“Zoffhrger R M & EffIsoa E H. Primary peptic ulcerations of the jejunum associated

c413

1

53

34

291

23

27

398

45

16s

3

286

5

33

3

9

46

17

126

10

with islet cell tumors of the pancreas. Ann. Surg. 14Z7W-28, 1955. (4/@J3/CP)

tine and Luncet can sign~lcantly affect (115), than “regular” articles not previ-the impact calculations. ousiy presented elsewhere (103). And

Surgery, in contrast, published slight- these proceedings papers received theIy more proceedings articles in 1978 greatest number of the 1978-1983 cita-

205

Table 8: Core surgery joumak (in chronologicorder) and the number of articles they publishedthat were cited at least 50 times in the SCJ@,1955-1983. A=core journal, B=year. C=num-ber of articles pubfished,

A BCActa Chir. %and. 1869 46Ann, Surg. 1885 701Amer. J. Surg. 1891 188Surg. Gynecol. Ohstet. 1905 413Brit. J. Sur& 1913 163Arch. Surg. 1920 286Surg, Cfirr. N, Amer. 1920 23J. Thorac, Cardiovaac. Surg. 1931 309Amer. Surg. 1935 9Surgery 1937 398J. Neurusurg. 1944 291Plast. Reconstr. Surg. 1946 53Ann. Roy. COU. Surg. EngJ. 1947 27Brit. J. Plast. Sur& 1948 17Acts Neurocbir. 1950 3Neuro-(%kurgk 1955 0Can. J, Surg. 1957 5Dis. Colon Rectum 1958 10J. Surg. Res, 1%1 26J. Trauma 1%1 33Ann. Thorac. Surg. 1965 45J. Pediat, Surg. 1966 34Surg. Neurol. 1973 3Clin. P1ast. Surg. 1974 0Neurosurgery 1977 1WOrid J, Surgery 1977 1Ann. Plastic Surg. 1978 0

tions (1,764) given to Sutgery that year.Articles were aclose second with 1,251cites. Many of the other journalsin thisstudy also publish proceedings papers.

Most-Cited Papers and Research Fronts

In these analyses, we also examine theindividual papers published in each ofthe core journals. Table 7 lists the most-cited article from each core surgeryjournal for the period 1955-1983. Six ofthese papers have already been the sub-ject of Citation Cfassic TM commentar-ies. Annals of Plastic Surgery, Clinics inPlastic Surgery, and Neuro-Chirwgieare not represented in the table becausenone of their articles met our selectioncriterion of a minimum of 50 citations.This often occurs in smalf fields. The fig-ures in column C provide the total num-ber of papers each journal pubfished

that were cited at least 50 times. Thesenumbers often reflect the age and sise ofa journal. So, for the journals in thkstudy, we have also listed these data inTable 8. For the most part, surgery jour-nals that began publishing more than 40years ago have the greatest number ofpubfished items cited at least 50 times inthe SCI from 1955 to 1983.

The most-cited paper was published inthe Annafs of Su~ery in 1955 by RobertM. Zollhger and Edwin H. Ellkon,Ohio State University College of Medi-cine, Columbus. The paper discusses thepossible relationship between pancreat-ic lesions and hypersecretion of gastricacid, one of the causes of peptic ulcer. lbThis relationship has since been identi-fied as the clinical ulcerogenic Z-E syn-drome (gastrinoma). Zollinger and Elli-son’s paper was cited 700 times from1955 to 1983, and 26 times in 1984 alone.Zolhnger stated that after its publica-tion, “. .our hypothesis was accepted bymany and challenged by many duringthe next five years. But within ten years,a thousand or more case reports estab-lished the cliiical ulcerogenic Z-E syn-drome (gastrinoma) . . . . Recently, thesyndrome has been extensively cited be-cause of the introduction of Hz blockers,which for the fwst time permit drug con-trol of the excessive gastric hypersecre-tion .. . . Peptic ulcer remains a commonand d~abling d=order. Whale theoriginal paper was concerned only withthe management of patients with therare .. .(pancreatic tumor) syndrome, itsthrust has been to challenge the researchand cfilcal imaginations of many disci-plines to solve the enigma of the gastro-intestinal tract.”17

The second most-cited paper de-scribes an issue of indirect but great imp-ortance to surgery-the use of intra-venous infusions. Stanley J. Dudnck andcolleagues, then at the School of Medi-cine, University of Pennsylvania, Phila-delphia, discussed whether “tissue main-

206

tenance and synthesis and growth couldbe achieved exclusively by intravenousinfusion of basic nutrients for prolonged

*~18Their 1968 paPer wasperiods of time.published in Surgery and received 548citations from 1968 to 1983. It receivedan additional 24 citations in 1984. Dud-nck has published two other papers onth~ subject. I%zoHe also appeared in ourstudy of the 1,000 contemporary scien-tists most cited from 1965 to 1978.21Dudrick is now at St. Luke’s EpiscopalHospital, Houston, Texas, and is one ofthe coauthors of another paper identi-fied later in Table 10.

C. Flanc, V.V. Kakkar, and M.B.Clarke, King’s College Hospital MedicalSchool, London, authored the thudmost-cited paper, “The detection of ve-nous thrombosis of the legs usinglz51-labelled fibrinogen,” published inthe Bn”ti.rh Journal of Swgery in 1968.The authors felt that” .. .the early detec-tion of venous thrombosis of the legs isof the utmost importance if the treat-ment of this condhion.. .is to be im-proved .. . . The diagnosis of silent venousthrombosis in the legs depends on moresensitive methods of detection, and themost promising of these seems to be theradioactive fibrinogen technique .’”22The paper has been cited more than 450

times. Kakkar also authored an article inTable 7 that discusses the diagnosis ofdeep vein thrombosis using 12SIfibrino-gen. It was published in A rchives of Sur-gery in 1972, and has since been citedabout 250 times.

In Table 9, we list the 1983 SC1 re-search fronts that include citing articlesfrom core surgery journals. These pa-pers were published in 1983 and cited thearticles that are core papers in the re-search fronts listed in Table 9. Onlythose research fronts that had at least 50citing documents from the 27 surgeryjournals are included here. As the list in-dicates, surgery is indeed a multidkci-plinary field. Several fronts on the treat-ment and analysis of different types ofcancer appear in the list. And it also in-cludes fronts on coronary, liver, andpancreatic disorders, as well as head in-juries and platelet function.

Two papers from the list of most-citedarticles are core documents in researchfronts in Table 9. V.Y. Bakamjian’s 1965paper from Piastic and ReconstmctiveSurgery discusses a two-stage methodfor pharyngoesophageal reconstructionwith a primary pectoral sktn flap. It wascited 243 times from 1955 to 1983, and 23times in 1984 alone. And it is core to re-search front #83-1 118, “Use of myocuta-

Tabfa 91 The 1983 SCF’ research front specialties that contain citing ducuments publiihed in core surgeryjournals. A= research front number. B =title. C =number of core surgery journals which cite the re-search front/number of 1983 citations from these core joumafs.

A

83-007783-013683-015783-cr2398W3425

83-046583-048183-052683-0527

83-1032

B

Survival anafyaia and prognostic factors in cancerDiagnnaia and treatment of intracranial hernatomaa and other head iniuriesDmgnuais and treatment of fiver d~rders including carcinomasGaatrointoadnal function, absmption characteristics and dwrdersEmdrmunental effects on and surgical treatment of coronary d~rdersEchocardlogmpftic evaluation of enducardkis, vafvtdar stenosis and pancreatic

dmrdersParenteraf nutrition and aaaociated bacterial infections especirdfy by staphylococciMyocutaneous naps in reconstructive surgery clbricaf studtes and evaluationsDisgnoaia and treatment of colorectal cancerProstaglandins, thrombuxmres and other subatsnces in platelet activation and functionManagement of vsactdarization, infection and other problems of aortic reconstructive

surgeryChemicaf aapccts of periphemf artery, intracranial and ccmbml aneurysms

c

12/7314/110

15/ 6212/609/50

13/74

13/7118/167

11/7817/92

15/192

5/60

....xi.w—

207

Ffsure 2: Higher-level, multidimensional scaling map for research front #83-C-481, “Myocutaneous flaps m~econstruc~ive surgery; clinical studies and e~alua_tions.”

6292

cwc,lmnm, or tfla flaro,ld M@ ml,Varydmld, d the,, K.stooerm,w Wamlant

\

tcamng elmrm mmroscqwc srwi i-of WTlw,m,mtal flap! ad mfle,

1744 _ .f ..mvmc.Jm 81MoMO=

IS-ant of k,. flap Mum by flu.r.mew!c dy. injection 8752

\2~,“ *, ,mmlta1m#.r.su rwd $t”de, ,“volvmgm,crwascu lsr ma,t.arnosm, free f lam end bme waf u

neous flaps in reconstruction of thebreast and other regions.” ThK topic issubtended by the higher-level clustermap of research fronts named “Myocu-taneous flaps in reconstructive surgery;clinical studies and evaluations”(#83-0481). As shown in Figure 2,#83-1 118 is linked to #83-4682, “Flapsand facial reconstruction in head andneck surgery; treatment of fractures andcongenital disorders, ” and #83-5022,“Experimental microsurgical studies in-volving microvascular anastomoses, freeflaps and bone grafts.”

The French-Dublin 1977 paper fromTable 7 discusses the value of CT, anX-ray scanning technique that elirnLnates distracting shadows and clarifiesspecific areas on X rays, in managinghead injuries. Thw paper is core to re-search front #83-0077, “Diagnosis andtreatment of intracranial hematomasand other head injuries.” CT is an area of

r

biomedicine that has proliferated wide-ly. While many of its branches show upon the map in Figure 1, thk particularresearch topic is subtended by yet anoth-er part of the hierarchy. It is a point onan even higher-level map, cluster#83-0033, “Treatment of cardiac arrestand head injuries including intracranialhematomas.” And this is a point on amap of yet another level of the hierar-chy, “Clinical aspects of medicine”(#83-0005).

As you can see, we would have to pub-lish an entire A tlas of Swgical Researchto coverall the relevant areas. As anoth-er example, we have also provided a mapfor research front #83-0902, “Manage-ment of vasculaxization, infection andother problems of aortic reconstructivesurgery” (see Figure 3). Currently this isa relatively hot area of research.

In Figure 4, coronary surgery is shownin a map at the next level of clustering.

208

Figure 3: Higher-level, multidimensional scaling map for research front M3-0W3, “Management ofvascularization, infection and other problems of aortic reconstructive surgery.”

Wstowrmve dr.mqc end $wo,cal evaluation of h IwXanc!dal activity ofw. nd mfectmm fol Iowng clwlecw:w.rn y chl.rofw”ld,ne and OUml Wglcd UNaneo”, Wt,sepl,cs

4934

621sPmOIMnriW .amrn..td uwical patmntf10, cald,ac .,& Mld

/

.W and mm unocytcdmm id ch.rar. 51SSpon.par.tive nlonm.r, “g

Iernttu of vmcuk wafts and

/

and -Wrlent

D=ron prostheses4s79

.etrom-ko!+ cefazol,n end cef.. ,mn m mtmoporatwerwn PIICwons of 6+Xlmn,n*l aorw

Wptim 1,s,prophylax,* of SePsi!rwon*tr..tmn, analysis. fM.w.twa ri* f=mrs

1926 d wftw.tiw measures

20SS .rwrtovenoua f lst.la shunt,.Ihmbischemi.; .ic of angio.3raphym Ssess rewscul.cizm,.n

S813

Prwhvlacttc .m of rnefronidaz.le,.nt,bmt,.s end othev .wnts i. thePrwantl.n of In fectIonw! other

mm Cmnputtit.mowaphcm pl,cwwuof SU,$ely

acmn byp.saswafts ,.1 irnbsand themamwnenl IN “ascular$zw+n. re!al,on of aorwc Wmulwrn,

blocd flow c. graft Wv,val

dW2s

evaluation Of blocd flc.w @“dother facto” ,. the u% of nwd,f,ed dim,, of acqu,rwl hawt

human wnbiltcal wt. end of .adwr wbswcet for .IWIal @“d

\

d,se~, aort!c aneurysm, and

vein bvpw grafts inwfficmncv by echocwd,owphy 6232

Figure 4: Multidnensional scaling map for “Characteristics, treatment and prevention of arrhythmias,myocsrdial ischemia and other coronary dkorders.”

&v,r..rrmml effete. .md WW4 Wemm.nt ofcoronary dIsurdws

\

131 =mssment and tceatment1297 of coronary dims

role of calci.rn,.m“.acard,.t,Schem,, and ,U calcwn act,v,ty In wmapt.somm,nducernent “PO”coronary OCct.w.

and mm’. CLws

910

1W6

effmm.1 wm and IOXinson . ..mnd and m.sc 1.activttr

arreri.a.entr ic. Iar mrhythm,= end tfw asswale.d blcck mwh.nwna

I

bmwen htirt d,wamand d+etmy ch+lmtecend I,pids

432

synthml, ami releew6wt.lchol,m

v~..w. .fm.nrd iky fmmmyoca<d,al,“fsrctlo”,

1231

Table 10: Papers pubfished in non-core joumak listed in alphabetic order by first author. These articleswere cited at least 10 times by core surgery journals in 1983. A = 1983 citations from core surgery journals.B= total 1955- 19S4 SCF citations. C= bibliographic data. An (”) asterisk indicates that the paper was thesubject of a Citation C/assicTM commentary. The issue, year, and edition of Current ContentsO in wtilchthe commentary appeared follow the bibliographic reference.

A B c19 1440 Cox D R. Regression models and life-tables. J. Roy. Stati~t. .SOC.Ser. B. Metk.

34:187-202, 1972.14 255 Dukes C E. The class~lcation of cancer of the rectum. J. Pafhoi, Bacteno/.

35:323-32, 1932.22 1141 “GebrrrrE A. A generalized Wifcoxon test for comparing arbitrarily singly-censored

samples. Biometn”ka 52:203-23, 1965. (39/79/LS)14 98 Gerzol S G, Robbfrrs A H, lofmson W C, Bfrkett D H & Nerbsetb D C. Percutaneous

catheter drainage of abdominal abscesses. N. Engl. J, Med. 305:652-7, 1981,12 138 Gokfmm L, Csddera D L, Nussbaum S R, Sorrtfrwkk F S, Kmgstad D, Murray B,

Burke D S, O’MafJey T A, Cord A H, CapJan C H, Notan 1, Csrmbeffo B &Sfater E E. Multifactorial index of cardiac risk in noncardiac surgical procedures.N. Engl. J. Med. 297:845-50, 1977.

11 128 Goldrfng 1, McNmr,gfrt W, Scott A & GfJfespie G. Prophylactic oral anttiicrobial agentsin elective colonic surgery. furmet 2:997- 1CKX3,1975.

10 582 Heymann M A, Payne B D, Hoffman J J E & Rudofph A M. Blood flow measurementswith radionuclide-labeled particles. Prog. Cardio va.rc. Dis. 20:55-79, 1977.

24 237 Jennett B & Bond M. Assessment of outcome after severe brain damage. J.ancet1:48@4, 1975.

10 111 Iemett B, Teaadnfe G, Braakman R, Mfrrd.mfrondJ & KrrJJf.JonesR. Predicting outcomein indhidual patients after severe head injury, .%ncet 1:1031-4, 1976.

12 118 Iermett B, Teambsfe G, Galbraith S, Pkkard J, Grant H, Bmakmass R, Avezaat C,Maas A, Mfnderhoud J, Vecbt C J, Heiden J, SQSatfR, Caton W & Kmze T. Severehead injuries in three countries. J. Neurrrl, Neurosurg. Psychiat. 40:291-8, 1977.

38 2052 “Kapfan E L & Mefer P. Nonparametric estimation from incomplete observations.J. Amer. Sratisf. Assn. 53:457-81, 1958. (24/83/LS)

10 283 Law D K, Durfrfek S J & Abdoa N J. Immunocompetence of patients with protein-crdorie malnutrition. Ann. Jnfern, Med. 79:54>50, 1973,

19 111,601 ● Lowy O H, Rosebrorsgtt N 1, Farr A L & Randall R L Protein measurement with theFolin phenol reagent. J. Bio/, Chem. 193:265-75, 1951. (1/77)

18 1410 Peto R, Pfke M C, Armitage P, Breslow N E, Cox D R, Howard S V, Mantel N,McPherson K, Peto J & Smhb P G. Design and anafysis of randomized clinical triaLsrequiring prolonged observation of each patient. 11. Analysis and examples,Bn”t, J. Ckncer 35:1-39, 1977.

12 22 Robbfns T H. Rectus abdomimis myocutaneous flap for breast reconstruction.Aust. NZ J. Surg. 49:527-30, 1979.

11 42 Seeflg J M, Becker D P, fWlfer J D, Greenberg R P, Ward J D & Choi S C. Traumaticacute subdural hematoma. N. Eng/. J. Med. 304:1511-8, 1981.

12 65 .%mdt T M, SJuhrough F W, Pfepgras D G, Keams T P, Messlck J M &O’Faffon W M. Correlation of cerebral blood flow and electmrmcephalographic changesduring carotid endarterectomy. Moyo C/in, Proc. 56;533-43, 1981.

30 3CKJ Temdate G & lemsett B. Assessment of coma and impaired consciousness. Lancet2:81-4, 1974.

The “Environmental effects on and sur- Another interesting way of examininggical treatment of coronary disorders” is core surgery journals is by looking at therepresented by cluster #239. It is linked articles that they cited in 1983 that wereto two other large clusters on the “Rela- published in non-core journals. We se-tionship between heart disease and di - lected the articles for this study by theetary cholesterol and lipids’’(#200), and following method. First we processed all“Assessment and treatment of coronary the references cited in the 1983 editionsdkeases” (#131). Thu is not a typical of the 27 surgery journals. We created aclass~tcation system for medicine or for “mtil citation index” of the papers cited.any other subject. But scientists do not We then ranked these cited papers bypublish and do research based on a pn”- frequency. For Table 10, we includedon”Anstotefian, Dewey, or WHO meth- only those papers that were cited at leastods of classification. 10 times by the core surgery journals in

210

1983. Only 85 papers fell into this groupout of 70,000 cited items. Of these, lessthan 20 were published in non-core jour-nals.

It is not surprising that the New En-gland Journal of Medicine and Luncetare well represented in thk table. Butstatistical journals (.fournal of the Royal

Statistical Society Series B—Methodo-logical; f?iometn’ka; and Journa[ of theA men”can Statistical Amociation) alsoaccount for several papers. B. Jennett,University of Glasgow, Scotland, andcolleagues, published three of the pa-pers. These concern severe head injuriesand brain damage.

It may surprise some readers to learnthat the Lowry method for protein deter-mination also turns up on th~ list of “sur-gical” papers. Equally noteworthy, the1932 paper by C.E. Dukes on cancer ofthe rectum was still welf cited in 1983surgical papers. The Peto paper was dis-cussed in some detail in our recent anal-ysis of Citation Classics.~ From this typeof analysis, we have been able to identifymany such Citation Classics for the fieldof surgery. It is also significant thatamong the 65 articles from the core, 13were published in the Journal of Plasticand Reconstructive Surgery, perhaps in-dicating how rapidly new developmentsare taking place in that field. A completelist of these papers is available on re-quest. Please contact Abigail Grissom,Editorial Services, ISP.

Summary

When we compare the data for thecore journals in Tables 2 and 4, we findthat eight core surgery journals (Amen”-can Journal of Surgery; Annals of Sur-gery; Archives of Surgery; British Jour-nal of Surgery; Journal of Neurosu~ery;Journal of Thomcic and CardiovascularSurgery; Plastic and Reconstructive

Surgery; and Surgery) appear among thetop 10 journals in both tables. Thesejournals rank highest in terms of theirreferences to the core and the number ofcitations received from the core in 1983.Seven of these journals, excluding Plas-tic and Reconstructive Surgery, rank inthe top 10 journals when ranked by im-pact. And seven of the journals, exclud-ing the American Journal of Surgery, arein the top 10 journals when ranked byimmediacy. Clearly, then, these eightcore journals are the surgery journalsthat are most influential to surgeons andsurgical research. Like alf other special-ists, they also rely heavily on multidkci-plinary journals such as the Z?ew En-gland Journal of Medicine, Lancet, An-nals of Internal Medicine, Circulation,Cancer, and so on. Thk concludes ourcurrent analysis of core surgery journals.

*****

My thanks to Abigail Grissom and

Janet Robertson for their help in thepreparation of this essay. a1985 ISI

REFERENCES

1. Garfield E. Shopping for a surgeon. Essays of an information scientist.Philadelphia: 1S1 Press, 1980. Vol. 3. p. 111-5.

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