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Level of Evidence: Does It Change the Rate of Publication and Time to Publication of American Academy of Orthopaedic Surgeons Presentations?
Pramod B. Voleti, MD1; Derek J. Donegan, MD1; Tae Won B. Kim, MD1; Gwo-Chin Lee, MD1
1 Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104. E-mail address for G.-C. Lee: Gwo-Chin.Lee@uphs.upenn.edu
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Investigation performed at Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jan 02;95(1):e2 1-5. doi: 10.2106/JBJS.L.00046
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Presentations at the Annual Meetings of the American Academy of Orthopaedic Surgeons (AAOS) are often used to guide clinical practice, although many corresponding manuscripts are not published. The purpose of this study was to determine the relationship between level of evidence, rate of publication, and time to publication of presentations from an AAOS Annual Meeting.


A comprehensive literature search for all 756 studies (288 papers and 468 posters) presented at the 2001 AAOS Annual Meeting was performed to determine which of these studies were ultimately published in the peer-reviewed literature. The corresponding AAOS abstracts were each assigned a level of evidence (LOE) with use of a consensus approach and The Journal of Bone and Joint Surgery (JBJS)/AAOS LOE classification system. The rate of publication and mean time to publication for each LOE was then calculated and compared.


The overall publication rate for the 2001 AAOS paper and poster presentations was 49% after five years, and 58% after ten years. At five and ten-year intervals, respectively, 77% and 85% of Level I presentations were published; 69% and 74% of Level II presentations were published; 58% and 66% of Level III presentations were published; and 39% and 51% of Level IV presentations were published. Overall, there was a significant nonrandom difference in publication rates at both five and ten years by LOE (p values of ≤0.001). Level I and II presentations were 2.9 times more likely than Level III and IV presentations to be published after five years (95% confidence interval 1.9 to 4.5), and 2.5 times more likely to be published after ten years (95% confidence interval 1.6 to 4.0). A similar association between LOE and five and ten-year publication rates was observed for both the paper and poster subgroups. The mean time to publication was 0.9 years for Level I studies, 1.4 years for Level II studies, 2.1 years for Level III studies, and 2.7 years for Level IV studies.


The LOE of AAOS presentations is positively related to rate of publication and inversely related to time to publication. Presentations with higher levels of evidence are published in the peer-reviewed literature at a greater and faster rate than those with lower levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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