Continuing Authorship Proliferation in the Cardiothoracic Surgical Literature

Abstract

“Publish or perish” is a grim reality for many academic surgeons and has led to authorship proliferation and internationalization of the cardiothoracic surgical literature. We sought to examine whether these trends are continuing today. We reviewed 17 267 articles from 2007 to 2022 in the archives of the 3 leading cardiothoracic journals (European Journal of Cardiothoracic Surgery, EJCTS; Journal of Thoracic and Cardiovascular Surgery, JTCVS; Annals of Thoracic Surgery, ATS). Data on the number of authors and geographic origin were collected.

The mean number (± SE) of authors per article increased with time for all journals: from 6.5 ± 0.1 in 2007 to 9.0 ± 0.2 in 2022 for the EJCTS (P < .001), from 7.4 ± 0.1 in 2007 to 8.2 ± 0.2 in 2022 for the JTCVS (P < .001), and from 6.9 ± 0.1 in 2007 to 9.0 ± 0.2 in 2022 for the ATS(P < .001). North American institutions increasingly dominate JTCVS/ATS, whilst European manuscripts decline in all journals. Only EJCTS showed increasing internationalization.

Authorship proliferation continues in the 3 leading cardiothoracic surgical journals, reflecting the natural evolution of the demands of modern research and career progression.

Authorship of research publications has long been considered a hallmark of success in academic medicine.

INTRODUCTION

Authorship of research publications has long been considered a hallmark of success in academic medicine. A surgeon’s list of authored papers serves as evidence of their scholarly accomplishment and provides professional benefits such as research funding, promotion, and remuneration, and prestige among colleagues. However, the phrase “publish or perish” is becoming a grim reality for many surgeons, especially when competition for senior roles is high. There is a significant drive among aspiring surgeons to seek out publication opportunities, even from as early as medical school,¹ and this is mirrored across multiple surgical specialities.^2–4

In 2008, we published a 70-year review (1936-2006) of 3669 articles from the archives of the European Journal of Cardiothoracic Surgery (EJCTS), the Journal of Thoracic Surgery (now the Journal of Thoracic and Cardiovascular Surgery (JTCVS)), and the Annals of Thoracic Surgery (ATS) examining the authorship landscape.² This showed a significant increase in the number of authors per manuscript as well as a marked reduction in single/dual author papers. In contrast with this decline in lone researcher work, multi-authorship (≥6 authors) papers and multinational papers saw a significant increase. The current manuscript aims to assess whether authorship proliferation and internationalization has continued.

METHODS

We manually searched the online archives of the EJCTS, JTCVS, and ATS for all original articles from January 2007 to December 2022. Editorials, expert opinions, consensus statements, case reports and brief communications were excluded; data on number of authors and geographic origin, categorized as North America (United States and Canada), Europe, United Kingdom, East Asia (Japan, China, and other East Asian countries), or Other were collected. Articles from 2 or more of these were classified as Multinational. To minimize the effect of short-term fluctuations, 3-year rolling averages were selectively used to show trends over time. Data were tested for normality prior to analysis. Statistical differences in mean number of authors and geographic origin were analysed by using analysis of variance and the Pearson χ² test as appropriate. All P-values are 2-tailed at the 0.05 level without multiplicity adjustment. All analyses were performed using R Statistical Software (v4.3.1; R Core Team 2023). Patient consent was not relevant to this study.

RESULTS

A total of 17,267 articles were retrieved (EJCTS n = 4772; JTCVS n = 5183; ATS n = 7312). The mean number (± SE) of authors per article increased with time for all journals: from 6.5 ± 0.1 in 2007 to 9.0 ± 0.2 in 2022 for the EJCTS (P < .001), from 7.4 ± 0.1 in 2007 to 8.2 ± 0.2 in 2022 for the JTCVS (P < .001), and from 6.9 ± 0.1 in 2007 to 9.0 ± 0.2 in 2022 for the ATS(P < .001) (Figure 1A).

Figure 1.

(A) Mean Number of Authors per Year (Error Bars Indicate SE; P-Value for Mean Differences Over Time Calculated Using One-Way ANOVA). (B) Changing patterns of publications with 1 to 2, 3 to 5, and 6 or more authors over time (P-value for proportional differences over time calculated using Pearson χ²). Abbreviations: ATS = Annals of Thoracic Surgery; EJCTS = European Journal of Cardiothoracic Surgery; JTCVS = Journal of Thoracic and Cardiovascular Surgery.

The proportion of single/dual-author manuscripts decreased across all journals from 3.6% in 2007 to 0.5% in 2022 (P < .001), and 3-5 author manuscripts also decreased from 22.5% to 13.9% (P < .001) respectively. In contrast, articles with ≥6 authors increased from 73.9% to 85.6% (P < .001) (Figure 1B).

With regard to geographic origin, most manuscripts in the EJCTS were of European origin and the 3-year rolling average decreased over the study period from 51.3% to 46.4%, whereas multinational papers and those from East Asia increased from 22.7% to 33.9% (Figure 2A). Publications from North America were static at approximately 10%.

Figure 2.

(A) Geographic Origin of Articles in the European Journal of Cardiothoracic Surgery From 2007 to 2022, Rate Shown as a 3-Year Rolling Average. (B) Geographic origin of articles in the Journal of Thoracic and Cardiovascular Surgery from 2007 to 2022, rate shown as a 3-year rolling average. (C) Geographic origin of articles in the Annals of Thoracic Surgery from 2007 to 2022, rate shown as a 3-year rolling average. Abbreviations: NA = North America; UK = United Kingdom.

The majority of manuscripts in US journals were of North American origin, and the 3-year rolling average increased over the study period from 45.0% to 59.0% for JTCVS (Figure 2B) and from 49.6% to 62.1% for ATS (Figure 2C); in contrast, European contributions decreased reciprocally from 25.0% to 12.5% for JTCVS and from 26.1% to 12.2% for ATS. Multinational and East Asian publications did not exhibit major changes, whilst British contributions were consistently low.

DISCUSSION

Having examined 17,267 articles across 3 leading cardiothoracic surgical journals, we have shown that authorship proliferation has continued in cardiothoracic surgery. Manuscripts with 1 or 2 authors have become nearly non-existent and those with between 3 and 5 authors are following the same trend. Unsurprisingly, the number of papers with 6 or more authors is steadily increasing and makes up 85.6% of published research. Manuscripts from North American institutions increasingly dominate JTCVS and ATS whilst European manuscripts decline in all journals. Only the EJCTS showed an increasing multinational and East Asia scientific contribution.

These trends mirror other scientific fields. In a paper by Greene published in Nature in 2007, it was noted that the lone author manuscript has all but disappeared from the scientific literature and that some basic science research fields now regularly feature papers with more than 100 authors listed.⁵ Authorship proliferation is a common theme with recent reviews in other medical fields noting similar trends.^3,4

Several factors contribute to authorship proliferation. The growing complexity of modern scientific research necessitates collaborative efforts that draw upon a diverse range of expertise. Additionally, the need for multicentre and multinational patient recruitment, driven by the quest for robust data and broader applicability, contributes to the increasing list of authors on scientific papers. This reflects a positive aspect of science in that researchers from various backgrounds come together to work on complex problems in the common goal of improving care for our patients.⁶

However, as the number of authors on papers increases, it becomes more challenging to assess individual contributions accurately. This can raise ethical concerns surrounding the accountability and responsibility of named authors, particularly if “honorary” authors are included. The erosion of authorship integrity and accountability can be detrimental to the research community’s trust in scientific publications.⁷ A recent study uncovered that a quarter of respondents to a questionnaire on authorship practice believed there to be “honorary authors” on their published papers and that two-thirds of authors had co-authors who solely performed non-authorship tasks. Noruzi et al⁸ also found that 77% of respondents were aware of the International Committee of Medical Journal Editors’ (ICMJE) guidelines for authorship but less than half were aware of the issue of honorary authorship, and worryingly 12% stated that no guidelines had been followed when determining authorship.

In conclusion, the inexorable rise in authorship proliferation in cardiothoracic journals continues, which may reflect the natural evolution of the demands of modern research and career progression. Progressive internationalization (publications featuring multinational contributions from institutions outside the journal’s primary geographic region) is only seen in the EJCTS. The single/dual author manuscript has nearly become extinct and the same now appears to be happening for papers with less than 5 authors. While multidisciplinary teamwork and inclusive authorship practices have brought undeniable benefits, they have also given rise to concern surrounding the accountability and integrity of authorship. Striking a balance between fostering collaboration and maintaining the fundamental principles of authorship is crucial to preserving the credibility and quality of scientific research. To address the challenges posed by authorship proliferation, there is a growing need for transparency and adherence to authorship guidelines. Authors must ensure that all individuals listed as authors meet the criteria for meaningful contributions and that honorary authorship is discouraged where possible.

Glossary

Abbreviations

ATS

Annals of Thoracic Surgery

EJCTS

European Journal of Cardiothoracic Surgery

JTCVS

Journal of Thoracic and Cardiovascular Surgery

FUNDING

None declared.

CONFLICTS OF INTEREST

None declared.

DATA AVAILABILITY

The datasets were derived from the following sources in the public domain: https://academic.oup.com/ejcts/issue; https://www.jtcvs.org/issues; https://www.annalsthoracicsurgery.org/issues.