The Impact of Double vs. Single-blinded Review on Plastic Surgery Authorship

PURPOSE: Academic productivity remains an important metric in plastic surgery for promotion. However, opportunities for research, such as publication in peer-reviewed journals, may be inequal. In orthopedics, articles are significantly more likely to be accepted when famous authors and prestigious institutions are known at review time (single-blinded)1. No study to date has investigated the impact of peer review methodology on plastic surgery authorship. We aim to compare author characteristics of plastic surgery articles with single- and double-blinded review to identify potential disparities in publication opportunities. METHOD: Articles from all issues, excluding supplements, of Plastic and Reconstructive Surgery (PRS), Aesthetic Surgery Journal (ASJ), Aesthetic Plastic Surgery (APS), and Journal of Plastic, Reconstructive and Aesthetic Surgery (JPRAS) from September 2019 to September 2021 were reviewed. PRS and JPRAS use single-blinded review. ASJ and APS use double-blinded review. Original articles, viewpoint articles, review articles, case reports/series, and CME articles were included. Per article, the name and institution of first and senior author were recorded. Author genders were determined using the Gendorize.io as previously described^2. Doximity 2021 reputation rankings for integrated plastic surgery residency programs were utilized to estimate institutional prestige. Institutional plastic surgery division/department NIH funding was calculated by summing all rewards for full-time faculty as listed on the NIH RePORTER database. RESULTS: Overall, 2502 articles met inclusion criteria, with 1644 (65.7%) published after single-blind and 858 (34.3%) after double-blind review. Articles reviewed by a double-blinded process tended to have higher rates of male first authors (74.9% vs. 67.4%, p < 0.001), and first (71.2% vs. 50.7%, p < 0.001) and senior (70.3% vs. 49.6%, p<0.001) authors from non-US institutions than single-blinded. Geographic locations of the first and senior authors were also significantly associated with degree of blinding (p < 0.001). Articles reviewed by single-blinded processes tended to have first (10.2% vs. 2.7%, p < 0.001) and senior authors (10.9% vs. 3.7%, p = 0.009) affiliated with institutions with significantly more NIH funding than those that were reviewed double-blinded. Interestingly, while there was a trend of articles published in single-blinded journals having higher proportions of first (23.9% vs. 10.8%, p = 0.060) and senior authors (26.5% vs. 12.2%, p = 0.061) coming from institutions with Top 20 integrated programs, this just missed statistical significance. CONCLUSION: Single-blinded review tended to accept more articles authored by women, US institutions, and those with higher NIH funding. While this portends important strides towards gender equity in plastic surgery academia, international authors and those from smaller, less funded and reputable plastic surgery divisions/departments are still disadvantaged. This should signal careful consideration to current peer-review processes to make research opportunities more equitable. REFERENCES: 1. Okike K, Hug KT, Kocher MS, Leopold SS. Single-blind vs Double-blind Peer Review in the Setting of Author Prestige. JAMA. 2016 Sep 27;316(12):1315-6. doi: 10.1001/jama.2016.11014. PMID: 27673310. 2. Elango M, Asaad M, Kotta PA, Rajesh A, Kaakeh R, Mitchell DT, Tran NV. Gender Disparity in Abstract Presentation at Plastic Surgery Meetings. J Surg Res. 2021 Sep;265:204-211. doi: 10.1016/j.jss.2021.02.010. Epub 2021 May 2. PMID: 33951585.