Return of the Disruption Score: Fetal Surgery in the Spotlight (1975-2021)

Fetal surgery is a highly specialized multidisciplinary field which evolved from pediatric surgery and maternal-fetal medicine. The published works that define the field are found across the spectrum of subspeciality journals, making a comprehensive review of the literature difficult. The disruption score is a bibliometric tool which places each published work in the context of the existing literature with negative scores representing developmental works and positive scores representing disruptive works, which tend to be paradigm shifting. To our knowledge, this is the first study aiming to characterize developmental and disruptive papers in fetal surgery.

A set of literature searches were performed in PubMed/MEDLINE capturing articles on fetal conditions of neural tube defects (NTD), twin twin transfusion syndrome (TTTS), congenital diaphragmatic hernia (CDH), and congenital pulmonary airway malformation (CPAM) and their associated interventions. Each article was reviewed, and a disruption score (-1 to +1) was obtained. Disruption scores were available for articles published from 1975 to 2021. Articles were then categorized as either developmental (negative scores) or disruptive (positive score). Articles with the highest disruptive and developmental scores, along with the top cited, were identified.

Within the field of fetal surgery, the top cited and top developmental fetal surgery papers occurred most frequently in 2010-2015, while the top disruptive fetal surgery papers most frequently occurred after 2020. NTD and CPAM had a higher proportion of developmental papers, while CDH and TTTS demonstrated more disruptive works. While there was overlap among top cited and top developmental works, disruptive analysis provided depth to characterization of the literature.

This is the first attempt to characterize impactful works of research within fetal surgery using disruption score. This bibliometric analysis, compared to traditional methods, may highlight key articles facilitating advancement within fetal surgery.

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