Surgical research remains comic opera and maybe for good reasons

INTRODUCTION The quality of surgical research was criticised 25 years ago in a Lancet commentary, where an analysis showed that papers published in prestigious surgical journals were rarely randomised clinical trials, but typically simple case series. Therefore, the aim of the present paper was to conduct a new publication analysis to establish if this has changed. METHODS The January issues of the ten surgery and ten general medicine journals with the highest impact factors were analysed. Only original articles were included, and funding and study design were registered. RESULTS Medicine journals had higher impact factors (median 25.0 (range: 9.0-91.2)) than surgical journals (9.1 (7.0-14.8)) (p = 0.004). More randomised trials and fewer retrospective studies were recorded in medicine than in surgery, and more prospective studies were found among surgery than the medicine publications. Furthermore, funding was more frequently involved in medicine than in surgery papers (94% versus 62%, p less-than 0.00001). CONCLUSIONS In the field of surgery, randomised trials remain rare and the field is characterized by more retrospective studies being published than in the field of medicine. The reasons explaining why may be found in knowledge and research traditions, but funding opportunities may also play a role. Furthermore, in clinical trials in surgery, it may be difficult or occasionally impossible to employ a double-blind study design. FUNDING none. TRIAL REGISTRATION not relevant.