Female authorship opportunities have lagged behind those of their male counterparts, with gender disparities most prominent in surgical specialties. Our objective was to determine trends of female first, last, and first or last authorships across time and surgical specialties and whether female first or last authorship was associated with journal impact factor.
A systematic review of EMBASE (OvidSP®), MEDLINE (OvidSP®), and Cochrane (Wiley®) from inception till December 22,2017 was performed to identify all RCTs evaluating MIS versus classical surgical techniques. The primary outcome was female first, last and first or last authorship, with gender determined via an online search strategy and verified via Genderize.io. Secondary outcome was journal impact factor, recorded from Clarivate Analytics® InCites.
9,321 articles were identified. 489 met our inclusion/exclusion criteria. Sixty-eight (13.9%) first and 60 (12.3%) last female authors were identified. A positive linear trend for female first (R=0.35, Cochran-Armitage test for trend, p<0.001), last (R=0.30,p<0.001), and first or last authorships (R=0.40, p<0.001) over time was identified. This trend was observed across surgical specialties, except for orthopedics. The highest calculated percentages of female first, last, and first or last authorships by the year 2017 were seen in obstetrics and gynecology (33.8%, 32.0%, and 43.8%, respectively), all significantly lower than the corresponding percentage of the female obstetrics and gynecology workforce in 2017(57.0%). Neither female first nor last authorship positions were associated with journal impact factor.
A significant increase in female first and last authorship in RCTs of MIS techniques over the last three decades has been observed, but continued efforts to bridge this gender gap are sorely needed.

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