Performing an analysis of the JAAOS provides researchers with quantitative data that allows them to assess possible publication speed based on the characteristics of their study. As the first in-depth analysis of publishing patterns of the JAAOS to our knowledge, this study illustrates that, regarding article type, letters have the shortest time to acceptance of 5 days (IQR 2–10) and interventional studies have the longest time to acceptance with a median of 171 days (IQR 106-309.5). Regarding the article topic, this study shows that those involving COVID-19 had the shortest median time to acceptance at 62 days (IQR 2-121), while those involving diagnostics had the longest time to acceptance at 189 days (IQR 100.25–309.5). Importantly, this study also demonstrates that there is no significant difference in times to acceptance between male and female first authors, whose median times to acceptance were 133 days and 125 days, respectively.
While this is the first known study to analyze the publishing patterns of the JAAOS, other analyses have been completed regarding publishing speeds in other medical specialties. Mohanty et al. found that median time to acceptance in 2018 for anesthesiology journals was 120 days (IQR 83–167) [8]. Jain et al. reported a median time to acceptance of 107 days (IQR 66–168) across 14 spine journals [9]. Chen et al. reviewed articles from 50 ophthalmology journals and reported median time to acceptance of 133 days (IQR 100.5-171.5) [10]. In 2022, Chopra et al. analyzed 14 orthopaedic surgery journals and reported a mean time to acceptance of 119 days (IQR 78–165), suggesting that orthopaedic surgery journals have a competitive peer review time compared to journals of other specialties [3]. This study demonstrates that the JAAOS has an overall median time to acceptance of 130 days (IQR 81–197), indicating that the JAAOS has a comparable time to acceptance when compared to its peers in the field of orthopaedic, spine, plastic surgery, and ophthalmology journals. However, it is important to consider that this is comparing one journal to the average of many journals in other fields, and it may be that JAAOS is comparatively more competitive when compared to these journals individually.
Regarding article type, this study found that letters have the shortest median time to acceptance of 5 days (IQR 2–10), while interventional studies have the longest time to acceptance with a median of 171.5 days (IQR 106-309.5). Though there is a paucity of research related to how article type affects time to acceptance and publication, it is reasonable to conclude that experimental and evaluation studies may require a more thorough review process and therefore have a longer time to acceptance. Regarding article subject, this study found that articles relating to COVID-19 had the fastest time to acceptance with a median of 62 days (IQR 2-121), while those on diagnostics had the longest time to acceptance at 189.5 days (IQR 100.25–309.5). This suggests that studies analyzing and comparing diagnostic measures or surgical techniques (diagnostic studies) could be held to a higher standard of review. These results regarding COVID-19 articles follow a broader trend in literature of COVID-19 articles being published faster than non-COVID-19 articles. Various studies have reported that, during this time period, non-COVID-19 articles faced reduced odds of acceptance [11] and diminished numbers [12] while publication rates for COVID-19 articles increased [11]. On the time to publication of COVID-19 articles, one study of 20 orthopaedic surgery journals showed a median time to publication of 24.5 days for COVID-19 articles compared to a median of 129 days for articles published before the pandemic [13]. Our study is consistent with trends seen across medical journals of various specialties, as well as journals specific to orthopaedic surgery, showing that articles regarding COVID-19 are published faster than non-COVID-19 articles.
According to the Association of American Medical Colleges (AAMC) 2022 Physician Specialty Data Report, 37.1 percent of physicians in the United States identify as female. Within the field of orthopaedic surgery, that number was merely 5.9 percent [14]. Despite this, current numbers indicate that women make up the majority of medical school applicants, matriculants, and total enrollment [15]. Though medicine and orthopaedic surgery are making strides toward gender parity, in 2020 only 16 percent of orthopaedic surgery residents were female [16]. Due to historical discrepancies in male and female physician numbers, it is important to understand both the current dynamic, and how workforce demographics will be changing in the future. In research, women are less likely to be first author on papers in high-ranking medical journals [17]. In orthopedic surgery journals, women are less likely to have abstracts published [18], experience a longer time to publication [18], have fewer publications [19], and are cited fewer than their male counterparts [19]. Due to the scarcity of research directly studying gender on time to acceptance and publication in orthopaedic surgery journals, we sought to understand this relationship in the JAAOS. While the conclusion cannot be drawn for other specialties or other orthopaedic surgery journals, our study demonstrates the JAAOS has no difference in time to acceptance for papers with female first authors compared to male first authors.
The time to publication of scientific articles influences the implementation of research into clinical practice. Studies show an average of 17 years for research results to be implemented into clinical practice; therefore, discovering ways to speed up the process of dissemination of these results is increasingly important [20]. Publication speed is also important for the advancement of clinical practice and training throughout all stages of medicine. Current studies show that between 60% and 71% of orthopaedic surgery residency program directors view research as a central tenet of deciding which candidates to invite for an interview [21]. Furthermore, residents at higher-tier orthopaedic surgery residency programs generally have higher academic productivity when compared to residents at lower-tier programs [22]. Studies have found that medical students matching into orthopaedic surgery had significantly more publications and presentations compared to students matching into other specialties [5] and that academic rank of orthopaedic surgeons in the United States was positively correlated to academic productivity [23]. Due to the importance of research production in career advancement, it is important to understand publishing patterns of orthopaedic surgery journals to make informed decisions that can impact career progression.
In the last decade, artificial intelligence (AI) has become increasingly important to understanding publication patterns. Multiple studies have demonstrated an ability for AI algorithms to accurately predict manuscript acceptance or rejection from a given journal [24]. It has also been shown that AI models have the ability to predict the quality of a journal that an article is likely to be published in according to impact factor [25]. Despite the benefits of these algorithms in guiding journal selection and publication probability, these models fail to provide predictive value for articles time to acceptance in journals. Our algorithm, as described in Fig. 2, helps address this gap by portraying the specific time to acceptances based on article characteristics. For example, if an author submitted an interventional article in 2020 on COVID-19 to JAAOS then the average time to acceptance could be predicted as (81.5 + 4.8–44.4) = 41.9 days. This provides a valuable predictive algorithm for an author to estimate the amount of time to publish their article based on the main characteristics of the study. This model could possibly be applied to other journals and specialties to help researchers publish their work.
Our study has limitations. Primarily, nearly half of articles published in JAAOS during the established time frame were excluded due to lack of complete information. Though the majority of articles included date published, nearly half omitted date of submission, which made calculating the time to acceptance impossible and thus these articles were excluded from the analysis. Although this could potentially limit the power of the study, the analysis of over 1,000 peer-reviewed articles provides sufficient information for conclusions to be drawn. Additionally, only one journal was studied. Although this could limit generalizability, JAAOS is a well-respected journal within the field of orthopaedic surgery. Finally, it is unclear how the COVID-19 pandemic may have impacted article publication. It is clear that studies regarding COVID-19 were accepted for publication faster than those on other topics.