Stylish surgical writing: the state of the art surveyed

Abstract Introduction Glaring gaps exist between what most readers consider proficient writing and what academics typically publish. This study aimed to assess the writing styles of the 13 journals held in the highest esteem by 11 surgical specialties. Methods The first 1,000 words of the initial 10 articles published in January 2018 from the 11 journals affiliated with surgical specialty associations were assessed as well as the BMJ and Lancet. The primary effect measures were Flesch-Kincaid Readability Ease (FRES, range zero (difficult) to 100 (easy)) and Flesch-Kincaid Grade Level (FGL, range -3.40 to infinity), related to journal Impact Factor and article citations. Results FRES median was 18.2 (1.4–38.2) and FGL 16.3 (12–26.2). FRES was directly related to the use of be verbs (p=0.004), but inversely proportional to numbers of common abstract nouns, words per sentence, characters per word, authors, references, level of evidence, and Journal Impact Factor (all p<0.04). Citations were inversely related to FRES (rho -0.292, p<0.001; critical value 14.5 (OR 0.20 p<0.001)) and directly proportional to FGL (rho 0.279, p=0.001; critical value of 15.5 (OR 5.04 p=0.05)). The journal with the highest FRES (most readable) was the British Journal of Oral & Maxillo-Facial Surgery (median 30.4; total citations 5). Conclusion Big differences in writing style and readability were plain with FRES varying 28- and FGL two-fold. No journals had a FGL of <12 (reading age of >17 yr.). Superior Journal prestige, Impact Factor, and citations were not associated with better Flesch-Kincaid reading ease.