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BACKGROUND A new bibliometric index called the disruption score was recently proposed to identify innovative and paradigm-changing publications. OBJECTIVE The goal was to apply the disruption score to the colorectal surgery literature to provide the community with a repository of important research papers. DESIGN A bibliometric analysis. SETTINGS The 100 most disruptive and developmental publications in Diseases of the Colon and Rectum, Colorectal Disease, International Journal of Colorectal Disease, and Techniques in Coloproctology were identified from a validated dataset of disruption scores and linked with the iCite NIH tool to obtain citation counts. MAIN OUTCOME MEASURES Disruption score and citation count. RESULTS We identified 12,127 articles published in Diseases of the Colon and Rectum (n=8,109), International Journal of Colorectal Disease (n=1,912), Colorectal Disease (n=1,751), and Techniques in Coloproctology (n=355) between 1954-2014. Diseases of the Colon and Rectum had the most papers in the top 100 most disruptive and developmental lists. The disruptive papers were in the top 1% of the disruption score distribution in PubMed and were cited between 1 and 671 times. Being highly cited was weakly correlated with high disruption scores (r=0.09). Developmental papers had disruption scores that were more strongly correlated with citation count (r=0.18). LIMITATIONS Subject to limitations of bibliometric indices, which change over time. DISCUSSION The disruption score identified insightful and paradigm-changing studies in colorectal surgery. Interestingly, they include a wide range of topics and consistently identified editorials and case reports/case series as important research. This bibliometric analysis provides colorectal surgeons with a unique archive of research that can often be overlooked, but that may have scholarly significance. See Video Abstract at http://links.lww.com/DCR/B639 .

Some studies have suggested disparities in access to robotic colorectal surgery, however, it is unclear which factors are most meaningful in the determination of approach relative to laparoscopic or open surgery. This study aimed to identify the most influential factors contributing to robotic colorectal surgery utilization.We conducted a systematic review and random-effects meta-analysis of published studies that compared the utilization of robotic colorectal surgery versus laparoscopic or open surgery. Eligible studies were identified through PubMed, EMBASE, CINAHL, Cochrane CENTRAL, PsycINFO, and ProQuest Dissertations in September 2021.Twenty-nine studies were included in the analysis. Patients were less likely to undergo robotic versus laparoscopic surgery if they were female (OR = 0.91, 0.84-0.98), older (OR = 1.61, 1.38-1.88), had Medicare (OR = 0.84, 0.71-0.99), or had comorbidities (OR = 0.83, 0.77-0.91). Non-academic hospitals had lower odds of conducting robotic versus laparoscopic surgery (OR = 0.73, 0.62-0.86). Additional disparities were observed when comparing robotic with open surgery for patients who were Black (OR = 0.78, 0.71-0.86), had lower income (OR = 0.67, 0.62-0.74), had Medicaid (OR = 0.58, 0.43-0.80), or were uninsured (OR = 0.29, 0.21-0.39).When determining who undergoes robotic surgery, consideration of factors such as age and comorbid conditions may be clinically justified, while other factors seem less justifiable. Black patients and the underinsured were less likely to undergo robotic surgery. This study identifies nonclinical disparities in access to robotics that should be addressed to provide more equitable access to innovations in colorectal surgery.

Aiming to assess the association between measures of obesity and outcomes in coronary artery disease (CAD) patients. We included consecutive patients referred to cardiac rehabilitation because of prior CAD events, who were classified using BMI groups and sex-specific tertiles of waist-to-hip ratio (WHR). Follow-up was ascertained using a population-based, record linkage system that consists of complete data on all residents. A major cardiovascular event (MACE) was defined as the composite outcome including acute coronary syndromes, coronary revascularization, ventricular arrhythmias, stroke or death from any cause. The association between obesity measures and MACE was assessed using cox proportional hazards models adjusted for potential confounders. The cohort included 1529 patients (74% men) mean age ± SD 63.1±12.5 years, 40% were obese by BMI. Eighty-eight percent of men and 57% of women were classified as having central obesity by WHR. Median follow-up was 5.7 years and 415 patients had a MACE event. After adjustment, a high WHR tertile was a significant predictor for MACE in women (HR=1.85 [95% Cl: 1.16, 2.94]; p=0.01), but not in men (HR=0.92 [95%CI: 0.69, 1.22]; p=0.54). This relationship in women persisted after further adjustment for BMI (HR=1.75 [95%CI: 1.07, 2.87]; p=0.03). Obesity by BMI was not associated with MACE in either men (HR=1.07 [95%CI: 0.76, 1.51]; p=0.69) or women (HR=0.98 [95%CI: 0.62, 1.56]; p=0.95). In conclusion WHR is associated with a higher risk of MACE among women with CAD but not in men. There was no obesity paradox when assessing obesity by BMI and MACE in CAD patients when including non-fatal events.