Peer review is intended to improve the quality and clarity of scientific reports. Upon rejection, authors receive suggestions from knowledgeable field experts. It is unclear whether authors take full advantage of the peer review process to improve their work before publication in another journal. We identified all actionable suggestions in rejection letters of 250 randomly selected manuscripts from a prominent orthopedic journal in 2012. We searched PubMed and Google Scholar and compared the published text to the initial submission to determine if reviewer suggestions were addressed. Two hundred (80%) of the 250 rejected manuscripts were published in another journal by July 2018. Among the 609 substantive actionable queries, 205 (34%) were addressed in the published manuscripts. The suggestions most frequently addressed were in the title and abstract (48%). Our findings suggest that authors often disregard advice from peer reviewers after rejection. Authors may regard the peer review process as particular to a journal rather than a process to optimize dissemination of useful, accurate knowledge in any media. Specialty journals might consider collaborating by using a single manuscript submission site that allows peer reviews to be transferred to the next journal, which helps holding authors accountable for making the suggested changes.
Keywords: Peer review; actionable suggestions; publications; reviewer suggestions.