OBJECTIVE: We sought to determine the extent to which reviewers' recommendations influence the final editorial disposition of manuscripts submitted for publication.

STUDY DESIGN: Five reviewers retrieved their electronic databases of obstetrical manuscripts that they had reviewed for Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology. The recommendations of each reviewer were grouped in 1 of 3 categories: rejection (or not acceptance), acceptance with major revisions, and acceptance with minor or no revisions. These recommendations were contrasted in the final editorial disposition of the manuscript, which was recorded as "accepted" or "rejected." The quality of the reviews was assessed in a random sample of 10% of the reviews, stratified by reviewer and journal.

RESULTS: A total of 635 reviews were analyzed. Overall, the most influential reviewers' recommendation was rejection, which was accompanied by 93% rejection rate. Recommendation for acceptance with minor or no revisions was accompanied by 67% acceptance rate whereas acceptance with major revisions was accompanied by 40% acceptance rate. There were no variations among reviewers regarding their degree of influence with respect to the final disposition of the manuscript. The final disposition of manuscripts was not influenced by the quality of the reviews nor reviewer's demographics including reviewer's age, year of first peer review, and years active in peer review.

CONCLUSION: The degree of influence on the final disposition of the manuscript depends on the type of recommendation. A recommendation for rejection was the most influential and it was associated with a high rate of rejection. Recommendations for acceptance or minor revisions were also influential but to a lesser degree.