Dura censor sed censor: A reviewer’s ongoing audit of 11 years in the journals of the European Association for Cardio-thoracic Surgery Aristotle D. Protopapas, Hutan Ashrafian, Thanos Athanasiou Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London is 76% LE text – normal TABLE text – normal INTRODUCTION The online submission of manuscripts has considerably streamlined biomedical publishing. The geographical limitations of submitting a paper have thus been minimised. The European Association for Cardio-thoracic Surgery is affiliated to two paper journals that jointly receive manuscripts by such an online submission tool. The reviewing process is led by an Associate Editor referring the manuscript to one or more reviewers. The reviewers submit recommendations to the Associate Editor who is responsible for the final decision: The reviewer’s recommendations and the editorial decisions may be simplified as one of 3 options: accept, send for revision or reject. The reviewers are not currently ‘blinded’ to the identity of the authors or the country of origin of the manuscript, a possible cause of bias. Our primary aim was to search for possible rejection bias towards the non –European manuscripts, especially the non-blinded reviewing process has been questioned in the past editorial meetings. METHODS One European reviewer's recommendations (FIGURE) in a cohort of manuscripts submitted to the Journals of the European Association for Cardio-thoracic Surgery from January 2004 till November 2015 were tested by chi square for association of the European or non-European origin of the manuscript to a recommendation to reject. RESULTS 99 manuscripts formed the cohort so far, 34 from Europe and the rest from the other continents. The agreement of the Associate Editor to the reviewer's recommendation was 76%. There was no bias detected by this method. CONCLUSION Non-European authorship is NOT disadvantaged by the journals of the European Association For Cardio-Thoracic Surgery, even without ‘blinding’ the reviewers. The audit continues to reach 100 observations, whereupon further statistical analysis will be attempted. FIGURE One Reviewer’s recommendations of more than a a decade in the Journals of The European Association for Cardio-thoracic Surgery