The increasing prominence of "non-surgical" articles in surgical literature

Publications in the surgical field have usually to do with technical skills (TS). However, the field peripheral to surgical procedures, which brings to bear non-technical skills (NTS) has been achieving increasing prominence. The goal of this study is to objectively assess the evolution of the two fields in surgical literature.

The authors perused all the articles published over a decade in four large-scale surgical journals and assigned them to the following three categories: (1) TS, (2) NTS or (3) miscellaneous. While the "TS group" included all aspects of surgical procedures, the "NTS group" comprised all aspects of non-surgical perioperative management, and the "miscellaneous group" was composed of all elements extraneous to the first two fields.

Of the 8775 articles analyzed, 4326 (49%) belonged to the TS group, 2343 (27%) to the NTS group and 2138 (24%) to the miscellaneous group. There was a significant decrease in the proportion of TS publications [61% in 2007, 44% in 2016 (P<0.001)], accompanied by a significant increase in the proportion of NTS publications (16% in 2007, 34% in 2016 (P<0,001)] over the course of the last decade. The trend first appeared in 2009 and has been confirmed and reinforced over the ensuing years.

The increasing prominence of non-surgical skills represents a major shift in the editorial choices of high impact surgical journals. It highlights the extent to which the surgical community is manifesting increased interest in the perioperative field, which is now drawing almost as much attention as surgical procedure per se.