Chronicling the COVID-19 pandemic through the plastic surgery literature.

Dear Sir,

The COVID-19 pandemic has dramatically affected plastic surgery across the globe. While its influence has readily been observed clinically, the pandemic has also affected the plastic surgery literature. The objective of this study was to characterize the effects of the COVID-19 pandemic on the plastic surgery literature.

Fifteen plastic surgery journals with the highest impact factor in 2019 from the Journal Citation Reports were selected. An advanced PubMed search was conducted to identify all articles published in these journals in 2020. A total of 6815 articles were identified and were subsequently screened. Articles with titles containing "COVID", "SARS", "pandemic", "corona", "COVID-19″, or "SARS-CoV-2″ were included, resulting in a total of 220 articles (3.2% of total articles). Mann-Whitney and Chi-squared tests were used to assess continuous and categorical variables respectively.

Eleven journals published articles on the COVID-19 pandemic and the Journal of Plastic, Reconstructive & Aesthetic Surgery published the highest proportion of COVID-related articles (11% vs. 2.4% all other journals, p < 0.001, Fig. 1 ). A total of 23 countries were represented in authorship, with the most common being the United States (32% [n = 69]), the United Kingdom (26% [n = 56]), and Italy (9% [n = 20]). The median number of authors and institutions per article was four and two respectively. Notably, there were 27 first authors who published more than one article and their contributions accounted for 28% of the COVID-related literature in plastic surgery.

Fig. 1

Number of COVID-19 Articles Published by Journal. Eleven of the fifteen journals surveyed published articles on the COVID-19 pandemic at time of review, December 5, 2020. The remaining four, The Cleft Palate-Craniofacial Journal, Clinics in Plastic Surgery, Journal of Plastic Surgery and Hand Surgery, and Seminars in Plastic Surgery, did not have titles that matched our search criteria at time of review. A. Raw numbers of COVID-related articles published in each of the eleven journals. B. Proportion of COVID-related articles out of all articles published in 2020 in each of the eleven journals.

Sixty percent of articles discussed the effects of COVID-19 on the field of plastic surgery overall, whereas the remainder discussed implications for specific subspecialties: 14% craniofacial, 10% reconstructive microsurgery, 9% cosmetic, 5% hand, and 2% dermatology. The overwhelming majority of articles were editorials or commentaries (59% [n = 131]), followed by original articles (33% [n = 72]), and guidelines (8% [n = 17]). Of the original articles, 32 (42%) were cross-sectional studies, 17 (23%) reviews, 13 (17%) surveys, seven case reports (9%), and seven (9%) were articles describing innovative solutions to challenges posed by COVID-19 (Fig. 2 ).

Fig. 2

Article and Study Type. The most common study type was editorials. Original articles represented a third of COVID-related literature and were comprised of cross-sectional studies, reviews, surveys, case reports, and innovative solutions.

The median time between submission and publication – either online or print – for all 220 articles was 55 days, with editorials having the fastest turnaround times (median for editorials, 47 days vs. non-editorial, 68 days; p-value = 0.003). Interestingly, median time to publication for original articles was 68 days, which is markedly faster than the 10.3 month publication timeline reported for plastic surgery journals before COVID-19. The month of May had the highest number of articles published at 45, followed by September at 44; this coincides with an approximately two month publication delay after the first global COVID-19 peak in March and the second peak in July. Manuscripts were relatively short in length, with a median word count of 822, and referenced a median of five sources. This is consistent with the finding that articles were predominantly editorials.

Despite the far-reaching effects of the COVID-19 pandemic, the plastic surgery community has demonstrated impressive resilience, mobilizing efficiently to meet the unique challenges imparted by the global crisis. A common theme throughout many of the early editorials was a call to action, with authors urging colleagues to consider their role in the pandemic. Inspiration soon gave way to collaboration, as authors from heavily affected regions, including Italy and China, chronicled their unique experiences and insights so as to arm the remainder of the community. The ensuing wave of original research articles made effective use of a growing body of data, providing granularity to the impact of COVID-19 on hospital systems, patient outcomes, and plastic surgery education.

Creativity and ingenuity have remained cornerstones of plastic surgery throughout the pandemic. Thus, despite a rapidly changing landscape, plastic surgeons have remained steadfast in the pursuit of excellent patient care, rigorous education, and the safety and longevity of the community. From embracing telehealth and virtual educational platforms to the use of 3-D printing in order to address shortages in personal protective equipment, , the plastic surgeon continues to adapt and innovate. Plastic surgery journals and their editorial teams have played an invaluable role in this process. By publishing articles in record time and enabling seamless, efficient communication, the field of plastic surgery can continue to progress rather than simply persist. This shared experience of being a part of the plastic surgery community during the COVID-19 pandemic will forever be preserved in the literature.

Declaration of Competing Interest

None