Discussion

This study sought to quantitatively analyze whether the reduced time spent in surgical practice translated into an increase in scientific and clinical academic productivity, specifically by looking at neurosurgery, stroke neurology, and neurointerventional surgery academic output during the period of lockdown.

The data clearly demonstrate that there was a momentous increase in the number of original submissions for the year 2020, which was largely beyond the predicted value for the year using a linear regression model. The effects were experienced across all of our represented journals. World Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics, in particular, have faced dramatic increases in total submissions of over 50% compared with the previous year which cannot be accounted for by the historical yearly average percent increases. Neurosurgery, Journal of Neurosurgery, Stroke, American Journal of Neuroradiology, and Journal of NeuroInterventional Surgery have all shown increases for 2020 of over 25%, with their total submission counts similarly well above their respective predicted values.

While the restrictions of the pandemic created increased time for clinical research, it has also created substantial challenges to ongoing research efforts. A survey study of neurointerventional research centers revealed widespread disruptions in aneurysm and stroke clinical trials due to missed enrollments and protocol deviations from missed clinical or imaging follow-up.15 Similar reductions in oncologic clinical trial enrollment have been reported.16

Given the dramatic increase in submissions for 2020 in the setting of widespread disruptions in ongoing prospective studies, one could argue that the quality of submissions may have decreased during the pandemic lockdown period. We sought to investigate this relationship by using rejection rate as a surrogate from the five journals that were able to provide these data. The rejection rates for the journals that could supply this information did not appear to differ significantly from the rates from previous years (p=0.387), suggesting that the quality of the submissions may have been maintained during the pandemic lockdown despite a large surge in the number of submissions. It is noted that the rate of rejections may be driven in certain journals by the number of issues printed per year as well as the allocated number of pages dictated by the publisher.

When the published articles from the same journals within the same time frame were categorized into COVID-19 pandemic related and non-related, just under 7% of all new article submissions during the pandemic time period were COVID-19 related. There are two ways in which the sharp increases in original submissions can be interpreted: that this is a natural consequence of an increased amount of untapped topics that have now been made available to explore in the wake of COVID-19,17 or that this is a consequence of the unprecedentedly increased time neurosurgeons, stroke neurologists, neurointerventionalists, and trainees have had due to the reductions in the clinical and surgical workload. Both may, in part, help to explain the 2020 surge, yet the relatively small percentage of COVID-19 related articles in comparison with the total number of articles published seems to lend more credence to the latter interpretation that academic physicians across the globe have used this unstructured time to advance scientific knowledge.

Although similar quantitative studies of COVID-19 and its effect on neurosurgical academic output have not been published, it is possible to compare the findings of this study with those of recent studies that used self-reported surveys. Pelargos et al described findings from a survey distributed to neurosurgery residents across the United States and Canada assessing changes to clinical and educational workload. More than 91% of residents reported that their clinical responsibilities have been reduced, and 65.2% stated that they have been spending increased time on clinical research.6 Zoia et al similarly conducted a survey of neurosurgery residents in Italy, and observed that participants homogeneously reported an increase in educational and scientific endeavors, with 55.7% reporting an increase in the production of scientific papers and research projects.18 Both findings are similar to our results, and serve to show the consequences of such increased attention directed towards academic engagement.

This study has important limitations. First, owing to the observational nature of our study, one cannot draw conclusions about the variables being studied and can only gather correlational relationships. The influence of confounders that could have affected the observed increase in journal submissions, separate from, or in coordination, with the pandemic, cannot fully be evaluated by the present study out of respect for the privacy of investigators. Second, there is a lag time between submission and publication, and we cannot account for COVID-related studies that are still in progress, leading to potential underestimation of the contribution of COVID-related articles to the increase. This was, however, offset by the fact that many COVID-related articles were fast tracked to publication during that period. Third, the study mainly contained neurosurgical journals, and looked only at clinical journals and not neuroscience journals. Clinical research was thought to be a better surrogate of academic productivity as the vast majority of laboratories were closed during the lockdown period. Lastly, there is no straightforward or uniform way in which to report on other potential submission quality metrics across the spectrum of included journals, such as study design or level of evidence, that would allow for standardization of article quality among the eight diverse journals.