Modeling the Adoption of 5760 Clinical Studies Into Practice Across 5 Surgical Specialties

No studies exist that explore the factors that influence the process of synthesizing new knowledge into perioperative standards of care and the operating room. We sought to model the adoption of clinical research into surgical practice and identify modifiable factors influencing the latency of this translation.

We created a data set comprised of all UpToDate articles between 2011 and 2020, sampled at 3-mo intervals, to explore how research is incorporated at the point-of-care (POC)-studying 5760 new references from 204 journals across five surgical specialties, compared to all uncited articles published during the same interval. UpToDate authors serve as specialty curators of the vast surgical literature, with an audience of more than a million clinicians in over 180 countries across 3200 institutions. Unlike society guidelines, UpToDate also provides the necessary granularity to quantify the time in bringing research to the bedside. Our main outcomes are citation rates and time-to-citation, split by specialty, journal, article type, and topics. We also model the influence of impact factor, geography, and funding and, finally, propose new impact indices to help with prioritizing surgical literature.

We highlight variation in adoption of clinical research by specialty. We show, despite representing a lower quality of evidence, surgical case reports are one of the most cited article types. Furthermore, most clinical trials (94%-100%) in surgical journals are never incorporated into POC reference lists. While few, pragmatic trials were the most likely to be cited of any article type in any surgical specialty (40%). Journal impact factor did not correlate with time-to-citation or proportion of articles cited in three of five surgical specialties, suggesting differences in how specialties synthesize/value research from specialty journals. Our two metrics, the Clinical Relevancy and Immediacy Indices, were defined to capture this impact/relevance to surgical practice. Of the five surgical subspecialties, gynecology references were >5-fold more likely to get cited, had a larger fraction of higher quality evidence incorporated, and demonstrated more success with POC adoption of practice guidelines. We also quantified the cost of translating research to surgical practice per specialty and generated maps that highlight institutions successful in translating research to the POC. The higher expenditure of National Institutes of Health funding in gynecology may reflect the cost of higher quality research per citation.

Understanding translational latency is the first step to exposing blocks that slow the adoption of research into everyday surgical practice and to understanding why increasing research funding has not yielded comparative gains in surgical outcomes. Our approach reveals new methods to monitoring the efficiency of research investments and evaluating the efficacy of policies influencing the translation of research to surgical practice.