[Independence in Plastic Surgery - Benefit or Barrier? Analysis of the Publication Performance in Academic Plastic Surgery Depending on Varying Organisational Structures].
BACKGROUND
Despite its recognition as an independent specialty, at German university hospitals the field of plastic surgery is still underrepresented in terms of independent departments with a dedicated research focus. The aim of this study was to analyse the publication performance within the German academic plastic surgery environment and to compare independent departments and dependent, subordinate organisational structures regarding their publication performance.


METHODS
Organisational structures and number of attending doctors in German university hospitals were examined via a website analysis. A pubmed analysis was applied to assess the publication performance (number of publications, cumulative impact factor, impact factor/publication, number of publications/MD, number of publications/unit) between 2009 and 2013. In a journal analysis the distribution of the cumulative impact factor and number of publications in different journals as well as the development of the impact factor in the top journals were analysed.


RESULTS
Out of all 35 university hospitals there exist 12 independent departments for plastic surgery and 8 subordinate organisational structures. In 15 university hospitals there were no designated plastic surgery units. The number of attending doctors differed considerably between independent departments (3.6 attending doctors/unit) and subordinate organisational structures (1.1 attending doctors/unit). The majority of publications (89.0%) and of the cumulative impact factor (91.2%) as well as most of the publications/MD (54 publications/year) and publications/unit (61 publications/year) were created within the independent departments. Only in departments top publications with an impact factor > 5 were published. In general a negative trend regarding the number of publications (- 13.4%) and cumulative impact factor (- 28.9%) was observed. 58.4% of all publications were distributed over the top 10 journals. Within the latter the majority of articles were published in English journals (60% of publications, 79.9% of the cumulative impact factor). The average impact factor of the top 10 journals increased by 13.5% from 2009 to 2013.


CONCLUSIONS
In contrast to subordinate and dependent organisational structures, independent departments of plastic surgery are the key performers within German academic plastic surgery which, however, suffers from a general declining publication performance. Hence, the type of organisational structure has a crucial influence on the research performance.
Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Campus Großhadern und Campus Innenstadt, Klinikum der Ludwig-Maximilians Universität München (LMU), München.
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Schubert
Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Campus Großhadern und Campus Innenstadt, Klinikum der Ludwig-Maximilians Universität München (LMU), München.
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Leitsch
Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Campus Großhadern und Campus Innenstadt, Klinikum der Ludwig-Maximilians Universität München (LMU), München.
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Haertnagl
Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Campus Großhadern und Campus Innenstadt, Klinikum der Ludwig-Maximilians Universität München (LMU), München.
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Haas
Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Campus Großhadern und Campus Innenstadt, Klinikum der Ludwig-Maximilians Universität München (LMU), München.
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Giunta
D005544:Forecasting; D005858:Germany; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000639:trends; D006748:Hospital Departments / Q000458:organization & administration* / Q000639:trends*; D006785:Hospitals, University / Q000458:organization & administration* / Q000639:trends*; D006801:Humans; D055811:Journal Impact Factor; D011643:Publishing / Q000458:organization & administration* / Q000639:trends; D012106:Research / Q000458:organization & administration* / Q000639:trends*; D013518:Surgery, Plastic / Q000458:organization & administration* / Q000639:trends*