Is less clinical research being published by surgeons in the United Kingdom?

Introduction: Concerns about the decline of surgical research have been expressed in parallel to the debate on the future of academic surgery in the United Kingdom. The aim of this study was to survey the output of UK surgeons in ten high impact general surgical journals between 1987 and 2009 to estimate whether less clinical academic activity is occurring. Methods: Ten general surgical journals with consistently the highest impact factors (1.2-7.9) were selected for review. All articles excepting letters and news articles were included in the study. The region of origin was identified for each paper and classified as USA, Japan, Europe, UK and Rest of the World (RoW). In articles from multiple centres, the region of the corresponding author was used. Results: Over the study period, the annual number of surgical papers published from the UK dropped both in absolute values (from 286 to 214) and as a percentage of global output (17.7-8.8%). The USA also saw a drop (from 867 to 763/yr), while the output has increased steadily for Europe (from 266 to 822/yr) and RoW (from 151 to 476/yr). In 2009, the percentage of total yearly output was roughly equal for Europe and USA (31-33%), UK and Japan (7-8%). Conclusions: These data suggests that clinical surgical research in the UK has suffered over the last 20 years. The declining emphasis on research as part of surgical training, the strategic decisions about fund allocation, and the increasing role of centres from Europe and RoW may all play a role. This limited "snapshot" fails to provide information on the output in journals focused on basic science. As more of the current research involves collaborations between clinicians and non-clinicians it is likely that many more papers were published in such journals during the period analysed. It remains to be monitored whether recent initiatives will strengthen academic surgery in the UK in future years. (C) 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.