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The Impact of Plastic and Reconstructive Surgery: By the Numbers

Rohrich, Rod J. M.D.; Weinstein, Aaron M.S.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 1501–1504
doi: 10.1097/PRS.0000000000001223

Dallas, Texas

Disclosure:Dr. Rohrich is the Editor-in-Chief of Plastic and Reconstructive Surgery and PRS Global Open. He receives instrument royalties from Eriem Surgical, Inc., and book royalties from Quality Medical Publishing and Taylor and Francis Publishing. Mr. Weinstein is the Managing Editor of Plastic and Reconstructive Surgery and PRS Global Open; he has no financial information to disclose.

Rod J. Rohrich, M.D., Plastic and Reconstructive Surgery, Brookriver Executive Center, 8150 Brookriver Drive, Suite S-415, Dallas, Texas 75247

Your journal, Plastic and Reconstructive Surgery (PRS), is often referred to as “the number one plastic surgery journal in the world”—and with good reason. This claim is well supported by many metrics,1 including the annual release of the Thomson Reuters Corporation Journal Citation Report. The 2014 Journal Citation numbers, which are based on 2013 citations of 2012 and 2011 articles in PRS, again reinforced the fact that the articles you publish and read in PRS are the most-cited articles in our field. Our 2014 Impact Factor of 3.328 indicates that the average PRS article was cited in the literature approximately 3.3 times. This number placed PRS as the nineteenth most-cited journal of 204 surgery titles.2 To put this into perspective, the next highest ranking journal in plastic surgery had a 2013 Impact Factor of 2.034, whereas the number one journal in the entire surgery category had an Impact Factor of 7.188.

Much has been written and discussed about the Impact Factor serving as a sole metric of a journal’s quality and impact. Many of the highest ranked journals and top publishers have signed The San Francisco Declaration of Research Assessment, indicating that, although “The Journal Impact Factor is frequently used as the primary parameter with which to compare the scientific output of individuals and institutions,” the calculations and resulting scores have “a number of well-documented deficiencies as a tool for research assessment.”3 We acknowledge the limitations of the Journal Citation Report; in fact, when we announced the 2014 Impact Factor to the PRS Editorial Board, we did so with the following note of caution:

…we all need to place Impact Factor and our ranking in the proper perspective. Journals that focus solely on Impact Factor lose sight of other important things. … Impact Factor is not the end-all-be-all on quality, importance, and the ultimate impact of a Journal.4

PRS uses multiple metrics to gauge and assess the quality of articles, including world-class peer review, grading for levels of evidence, designation of outcomes, written and video discussions by recognized experts, accurate Web metrics, third-party survey data, and public interest. We have recently begun exploring the value of “altmetrics” to help us further gauge the “social” response to our content. All of these metrics, when combined with the Journal Citation Report, provide a more robust picture of the quality of any journal. That said, Impact Factor is still a loud voice in directing journal submissions and readership, and is used as a de facto voice for quality. We believe that the tool is useful for providing a “snapshot” to examine the impact of a journal.

To better understand these numbers and what they mean for a journal such as PRS, which contains multiple topical “mini-journals” from cosmetic surgery to breast to pediatric and craniofacial, our editorial and publisher team analyzed the 2014 Journal Citation Report. Thomson Reuters reports every published article used in its calculations, providing the number of citations per article. Our team scoured the data, assigning each article to its respective PRS topical section (e.g., Breast, Cosmetic, Experimental) to discover the “impact factor” of each area of Plastic and Reconstructive Surgery (Table 1). As with any statistical analysis, there is the possibility of error in the numbers. Although Impact Factor should not be the sole voice in a conversation about a journal’s quality, we can still learn a lot by “drilling down” into the very interesting results of PRS’ 2014 Impact Factor numbers section by section.

Table 1

Table 1

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The Breast section of PRS is often the journal’s second or third most popular section, according to our Web traffic reports.5 However, our experiment showed that PRS Breast content, which includes breast reconstruction and reduction, is the highest cited content in the Journal, with an impact factor of 3.545, outperforming the Journal as a whole. This should have been no surprise: eight of the top 10 most-cited articles in 2013 (from 2011 and 2012) were published in the Breast section,6–12 including “A Meta-Analysis of Human Acellular Dermis and Submuscular Tissue Expander Breast Reconstruction” by Kim et al.,13 which was cited 25 times in 2013 and 52 times total at the time the Impact Factor was released in July of 2014.

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The Cosmetic section, which is usually the most-viewed section of content by at least a factor of 3,5 was not in our top five highest cited sections. With an Impact Factor of 2.149, the Cosmetic section was the eighth most-cited section in PRS, but it still ranks higher than other major cosmetic/aesthetic plastic surgery journals in the Journal Citation Report surgery category, which had Impact Factors of 2.034 and 1.189, respectively. This comparison is not presented to belittle the hard work, excellent content, and high-quality products that our colleagues publish. Instead, we present these facts to point out the relative “impact” of PRS’ Cosmetic content: the Cosmetic section of PRS is ostensibly the highest cited, highest impact cosmetic plastic surgery journal in the field. The most-cited PRS Cosmetic article in the time period was “Breast Augmentation Using Preexpansion and Autologous Fat Transplantation: A Clinical Radiographic Study,”14 which had been cited 33 times as of July of 2014.

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The Experimental section was the second highest rated section of PRS, with an Impact Factor of 2.603. This is a testament to the high-caliber literature that plastic surgery researchers publish in PRS. The Experimental article with the most all-time citations in our Journal for the 2014 calculation period was, “Human Adipose Stem Cells: Current Clinical Applications.”15

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PRS’ Hand section has seen an unprecedented period of growth both in the quantity and the quality of the topics covered. In 2011 and 2012, we published just under 60 Hand articles; but they were widely cited, with a section-wide citation index of 2.5. These data mean the PRS’ Hand section was cited more often than several dedicated hand journals, which had Impact Factors of 2.190, 1.810, and 1.655. The most-cited article in this section was “Indocyanine Green-Enhanced Lymphography for Upper Extremity Lymphedema: A Novel Severity Staging System Using Dermal Backflow Patterns,”16 which had been cited 31 total times as of July 2014. The second-most cited article was “Systematic Review of Flexor Tendon Rehabilitation Protocols in Zone II of the Hand.”17

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The Pediatric/Craniofacial section of PRS had a sectional Impact Factor of 1.512. The most cited article, “Evaluation of Terminology for Vascular Anomalies in Current Literature,”18 had been cited 27 times total as of July of 2014. The section-wide Impact Factor places the PRS section ahead of other pediatric-focused journals, which had respective Impact Factors of 1.370, 1.311, and 1.061; and ahead of craniofacial journals, which had Impact Factors of 1.106 and 0.676.

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The Reconstructive section of PRS is divided into three subcategories: Head and Neck, Trunk, and Lower Extremity. My team calculated the impact of each section as a unique number. Lower Extremity led the group, with an Impact Factor of 2.447; Head and Neck (2.267) and Trunk (2.209) were mere hundredths apart. The single most-cited Reconstructive article in the designated period was a Lower Extremity article entitled “Characteristic Indocyanine Green Lymphography Findings in Lower Extremity Lymphedema: The Generation of a Novel Lymphedema Severity Staging System Using Dermal Backflow Patterns,”19 with 42 total all-time citations as of July of 2014.

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It is worth noting that our final section, CME, which publishes one video-heavy, learning-based article and test per month, scored quite high compared with the other topical PRS sections. With an Impact Factor of 2.792, the CME section was the second highest group of articles (Breast was the highest). This is indicative not only of the careful, meticulous work of our CME authors, but of the excellent hands-on leadership of Don Lalonde, M.D., our CME/MOC Section Editor. The most-cited CME article was “Cleft Lip, Cleft Palate, and Velopharyngeal Insufficiency,”20 with 14 citations all time as of July of 2014. Although this number is lower than the “highs” of all the other sections, the relatively high overall Impact Factor for this section indicates that each CME article is cited routinely.

Throughout every issue of PRS, certain articles—as selected by Outcomes Section Editor Kevin Chung—are labeled as Outcomes articles. This indicator designates articles that are evidence and outcomes focused, and usually correlate to what we feel are important topics. The citation analysis data reflect this correlation. With an average citation of 4.457, articles labeled as “outcomes” were the highest-cited grouping of PRS content, and outperformed the Journal as a whole.

It is also worth indicating that PRS supplements perform quite well, and our 2011 Wound healing Supplement21 also outperformed the Journal as a whole, with a total Impact Factor calculation of 4.405. This multidisciplinary supplement, guest edited by Jeffrey Janis, M.D., and Chris Attinger, M.D., set a high bar for supplements and has been the successful model after which most subsequent supplements have been based. It will be interesting to see how PRS supplements from 2012 onward will be received and cited.

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With this deep dive into one still widely used metric, the Editorial Board and I had one aim: to drill into the Impact Factor and discover why Plastic and Reconstructive Surgery is rated the number one plastic surgery journal in the world according to the Thomson Reuters Impact Factor. With this analysis, you can see why: PRS is made up of the most cited Cosmetic, Hand, and Pediatric/Craniofacial articles; very highly cited Breast and CME content; and, very important, well-referenced Experimental and Reconstructive content. We attribute this success to our excellent reviewers; insightful Editorial Board; and the leadership and guidance of co-editor Jim Stuzin and our section editors, including those previously mentioned, and Drs. Maurice Nahabedian, David Hidalgo, Paul Cederna, Matt Concannon, Scott Bartlett, and Dennis Orgill.

The true driving forces behind the impact of our Journal are the incredible and inspired plastic surgeons from around the globe who continue to write, submit, and publish cutting-edge research and well-founded studies, and our broad, active readership. This exercise has proven one thing: no matter what journal plastic surgeons choose to publish in, plastic surgeons—reconstructive, aesthetic, hand, pediatric, craniofacial, and researchers—are making indelible impacts on the entire field, of which we as an entire community can be very proud.

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1. Proprietary Kantar Media Study.
2. . Plastic and Reconstructive Surgery 2013 Journal Citation Report.
3. The San Francisco Declaration on Research Assessment (DORA). Available at: Accessed December 5, 2014.
4. . Correspondence. August 8, 2014
5. . “PRS Web- Overview: Year-to-Date.” Adobe Marketing Cloud. Created: December 2, 2014 2:03 AM EST.
6. Liu AS, Kao HK, Reish RG, Hergrueter CA, May JW Jr, Guo L.. Postoperative complications in prosthesis-based breast reconstruction using acellular dermal matrix. Plast Reconstr Surg. 2011;127:1755–1762
7. Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E.. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg. 2011;127:514–524
8. Sbitany H, Serletti JM.. Acellular dermis-assisted prosthetic breast reconstruction: A systematic and critical review of efficacy and associated morbidity. Plast Reconstr Surg. 2011;128:1162–1169
9. Colwell AS, Damjanovic B, Zahedi B, Medford-Davis L, Hertl C, Austen WG Jr.. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: Indications, complications, trends, and costs. Plast Reconstr Surg. 2011;128:1170–1178
10. Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011;128:403e–410e
11. Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL.. The BREAST-Q: Further validation in independent clinical samples. Plast Reconstr Surg. 2012;129:293–302
12. Kim B, Roth C, Chung KC, et al. Anaplastic large cell lymphoma and breast implants: A systematic review. Plast Reconstr Surg. 2011;127:2141–2150
13. Kim JY, Davila AA, Persing S, et al. A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. Plast Reconstr Surg. 2012;129:28–41
14. Del Vecchio DA, Bucky LP.. Breast augmentation using preexpansion and autologous fat transplantation: A clinical radiographic study. Plast Reconstr Surg. 2011;127:2441–2450
15. Gir P, Oni G, Brown SA, Mojallal A.. Human adipose stem cells: Current clinical applications. Plast Reconstr Surg. 2012;129:1277–1290
16. Yamamoto T, Yamamoto N, Doi K, et al. Indocyanine green-enhanced lymphography for upper extremity lymphedema: A novel severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011;128:941–947
17. Chesney A, Chauhan A, Kattan A, Farrokhyar F, Thoma A.. Systematic review of flexor tendon rehabilitation protocols in zone II of the hand. Plast Reconstr Surg. 2011;127:1583–1592
18. Hassanein AH, Mulliken JB, Fishman SJ, Greene AK.. Evaluation of terminology for vascular anomalies in current literature. Plast Reconstr Surg. 2011;127:347–351
19. Yamamoto T, Narushima M, Doi K, et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: The generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011;127:1979–1986
20. Fisher DM, Sommerlad BC.. Cleft lip, cleft palate, and velopharyngeal insufficiency. Plast Reconstr Surg. 2011;128:342e–3603
21. Janis J, Attinger C.. Current concepts in wound healing: Update 2011. Plast Reconstr Surg. 2011;127(Suppl 1):7S–9S
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