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“Difficult Airway” Bibliometrics: Importance of Capturing the Correct Literature

Pandit, Jaideep J. DPhil, DM; Popat, Mansukh T. MBBS, FRCA

doi: 10.1213/ANE.0000000000002514
Letters to the Editor: Letter to the Editor

Published ahead of print October 5, 2017.

Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom,

Published ahead of print October 5, 2017.

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To the Editor

We appreciate the effort of García-Aroca et al1 to ascertain the bibliometric data relating to “difficult airway” literature. This is increasingly important in assessing individual and departmental performance,2 especially in national exercises like the UK’s Research Excellence Framework. The Research Excellence Framework is the means by which the UK government disburses funding to universities in large part based on number of publications.3 The process has been well described in a national report into the state of UK academic anesthesia,4 and most UK departments and researchers are very familiar with their own bibliometric scores.

It was therefore a surprise to see in the paper of García-Aroca et al1 that the overall number of publications is so low and the citation scores are so modest. We cannot reconcile these data with publicly verified databases in the United Kingdom. For example, our own difficult airway-related publication rates for the periods shown are respectively 29 (J.J.P.) and 42 (M.T.P.); our total publications being significantly higher than this. In respect of citations, the RAND Corporation has identified that our Oxford anesthesia department ranks top in the United Kingdom (the major contribution being from our own airway-related research), with citations >50% higher than the next-ranked university, and more than double the third ranked (see Thus, we already know that in the specific field of difficult airway research, Oxford ranks easily highest in the United Kingdom.

There are also some unfortunate errors in their Figure 6, putatively displaying national-level institutional links. The “University of Oxford” and “Oxford Radcliffe Hospital” are shown as separate, when in fact for research purposes, they are identical. The “University of Wales” is an old, overarching term for universities now called by their modern names like “Cardiff University.” The “University of Wales Hospital” should actually read “University Hospital of Wales”—a center most closely connected with Cardiff University (ie, these 2 being synonymous). These are entirely understandable errors from the distance the authors are writing, but they have the unfortunate effect of greatly diluting the perceived output of the centers concerned.

There seem to be 2 possibilities. Either the data of García-Aroca et al1 are incorrect or, more likely, they have been overly restrictive in their search terms. They may have confined their searches to difficult airway but excluded relevant terms such as “airway management” or “devices,” etc. If so, readers will need to interpret their data with extreme caution. The results will then have little or nothing to do with being prolific in actual difficult airway research, as measured by objective national exercises, but rather only with authors’ use of the words “difficult airway.” The latter is a trivial measure of performance.

We commend the contribution of García-Aroca et al1 to bibliometric analysis, but much more detail is needed for more accurate interpretation of their data, or their paper could be interpreted as misleading.

Jaideep J. Pandit, DPhil, DMMansukh T. Popat, MBBS, FRCANuffield Department of AnaestheticsOxford University Hospitals NHS Foundation TrustOxford, United

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1. García-Aroca MÁ, Pandiella-Dominique A, Navarro-Suay R, et al.Analysis of production, impact, and scientific collaboration on difficult airway through the Web of Science and Scopus (1981-2013). Anesth Analg. 2017;124:1886–1896.
2. Pandit JJAnaesthetic research in the United Kingdom: publishing or perishing? Anaesthesia. 2008;63:225–227.
3. Pandit JJMeasuring academic productivity: don’t drop your ‘h’s!. Anaesthesia. 2011;66:861–864.
4. Pandit JJEditorial I: The national strategy for academic anaesthesia. A personal view on its implications for our specialty. Br J Anaesth. 2006;96:411–414.
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