Low Middle Income Countries and Academic Productivity of Neurosurgery: A Quantitative Analysis From Pakistan

Neurosurgical training and practice rely heavily on research, which is a pivotal marker of academic productivity. This study investigates the current landscape of neurosurgery publications originating from Pakistan, encompassing overall research output, prevalent topics, and disparities across institutions and regions. Electronic databases, including PubMed, Scopus, Web of Science, and ScienceDirect, were systematically searched up to November 1, 2023, using specified keywords. Data pertaining to authors, publication years, affiliations, article types, citations, journals, impact factors, and topics were extracted from eligible articles. From inception till Nov 1, 2023, a total of 825 articles relating to Neurosurgery were published from Pakistan. A significant upsurge in publications occurred from 2017 onwards, reaching its peak in 2021 with 115 studies published. A total of 12 articles had 100 or more citations. The majority of publications were original articles (n = 592, 71.7 %) followed by reviews (n = 144, 17.5 %), predominantly focusing on brain-related topics (n = 203, 24.6 %), neuro-oncology (n = 164, 19.8 %), spine (n = 145, 17.5 %), and trauma (n = 143. 17.3 %). Vascular neurosurgery contributed 88 studies, general neurosurgery 40, neuroradiology 28, functional neurosurgery 14, and pediatric neurosurgery 17. Shamim MS was the top author with the most number of publications (n = 89), followed by Enam SA (n = 51). JPMA (n = 93) and Surgical Neurology International (n = 71) emerged as the top publishing journals. Aga Khan University and Hospital emerged as the most prolific contributor with 236 original studies conducted. There exists notable regional disparities and a lack of experimental studies. While there has been a substantial increase in neurosurgical publications from Pakistan in recent years, significant regional disparities and challenges persist. Addressing these issues is crucial to fostering a more robust research environment in neurosurgery within the country.