Article Processing Charges in General Surgery Journals: Implications for Equitable Publishing Access in Low-Income...

Open access publishing promotes broad dissemination of scientific knowledge, enhancing transparency and accessibility. However, article processing charges (APCs) required by many journals create significant financial barriers, particularly for researchers from low- and middle-income countries (LMICs). Prior studies across multiple disciplines have shown that APCs disproportionately restrict LMIC authors' ability to publish, perpetuating inequities in academic representation. The impact of APCs within general surgery remains underexplored. This study aims to quantify APCs in surgical publishing and evaluate the equity of fee structures for authors from LMICs.

A cross-sectional analysis of APCs in general surgery publishing was performed using journals identified via SCImago Journal & Country Rank. Journals were classified as fully open access (OA), with all articles freely accessible, or hybrid, subscription-based journals offering optional OA publication for a fee. Data on APC amounts, reductions for LMIC authors, publishing model, country of origin, and impact factor (IF) were extracted from publicly available sites. Countries of origin were categorized by World Bank income levels. IFs were compared between journals offering and not offering APC reductions for LMIC authors using the Mann-Whitney U test. All APCs were standardized to US dollars.

A total of 40 general surgery journals were identified and included in the analysis with 90% (36/40) charging APCs. Among these, 67% (24/36) were hybrid journals charging fees only for OA publication, whereas 33% (12/36) were fully OA. Of the journals charging APCs, 42% (15/36) offered reduced fees for LMIC authors. The median full APC for journals offering discounts was $3720 (interquartile range [IQR]: $3090-$3950), compared with $2904.50 [IQR: $1618.50-$3895] for those without discounts. Most journals (82.5%, 33/40) were based in high-income countries (HICs); among these, 27.3% (9/33) were fully OA, 72.7% (24/33) were hybrid, and 45.4% (15/33) offered reduced APCs for LMIC authors. Journals based in LMICs comprised 17.5% (7/40) of the total. All LMIC journals were fully OA, with 57% (4/7) charging no APCs. The remaining 43% (3/7) did not offer reductions but had lower median APCs of $500 [IQR: $150-$1500] compared to high-income country journals, with a median of $3650 [IQR: $2500-$3950]. Mann-Whitney U testing showed that journals offering reduced APCs for LMICs had significantly higher IFs than those without discounts (P = 0.04).

Most general surgery journals levy high APCs that can create barriers for authors and perpetuate inequities in academic representation. Although 42% of the journals offer reduced charges, APC amounts remain substantial. LMIC-based journals show fully open access publishing can be achieved at minimal or no cost. These findings offer actionable, data-driven insights for key stakeholders to implement broader APC reductions and promote equitable access to surgical publishing.