Abstract
Purpose: Article processing charges (APCs) are central to author-paid open access (OA) publishing. Disparities appear in oncology, pathology, and global surgery, but not colorectal surgery, spanning coloproctology, general surgery, gastroenterology, and oncology journals. We examined APC levels, citation-impact linkage, and authorship geography.Methods: This study was a cross-sectional bibliometric analysis of 32 journals (MEDLINE/PubMed search). APCs (publisher-direct 2026) and 2024 citation metrics (Journal Impact Factor [JIF], SCImago Journal Rank [SJR], SCImago H-index) were extracted. First- and last-author countries for all 2024–2025 articles (n=31,164) were mapped to World Bank income groups. Multivariable ordinary least squares regression modeled log10(APC) on publisher group, region, OA model, and log10(JIF 2024).Results: Median APC was US $3,980 (interquartile range, $3,580–$4,390), varying by region: $1,467 in Asia, $3,840 in the United Kingdom, $4,140 in Western Europe, and $4,175 in the United States. APC correlated with the SCImago H-index (ρ=0.51, P=0.003) but not with JIF (P=0.25) or SJR (P=0.13). Of 30,320 articles, first authors were from high-income countries in 62.5%, upper-middle-income countries in 34.7%, and lower-middle- or low-income countries in 2.8%; China (30.9%), the United States (23.1%), and Japan (8.0%) were the leading countries. First authors were more often from non–high-income countries than last authors (median difference, +0.68 percentage points; P<0.001). In multivariable regression (R2=0.90), society-direct publishing was associated with lower APCs (β=−0.44, P<0.001), whereas US-based publishing (β=+0.18, P=0.019), UK-based publishing (β=+0.16, P=0.037), and a hybrid OA model (β=+0.15, P=0.014) were associated with higher APCs. JIF was not independently associated with APC (P=0.93).Conclusion: Colorectal surgery APCs are high and decoupled from citation impact after adjustment, with underrepresentation of lower-resource-setting authors, especially at senior-author level. Society-owned and Asia-based journals offer lower-cost alternatives but remain a minority.