Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands

• Published in: BJOG : an international journal of obstetrics and gynaecology 2014-03, Vol.121 (4), p.487-497
• Main Authors: Vonk Noordegraaf, A, Anema, JR, Louwerse, MD, Heymans, MW, Mechelen, W, Brölmann, HAM, Huirne, JAF
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Decision Support Techniques; Female; Follow-Up Studies; Gynaecological surgery; Gynecologic Surgical Procedures; Gynecology; Humans; hysterectomy; Intraoperative Complications; Kaplan-Meier Estimate; laparoscopic adnexal surgery; Middle Aged; Multivariate Analysis; Netherlands; Postoperative Complications; prediction model; predictor; Preoperative Period; Prognosis; Proportional Hazards Models; Prospective Studies; return to work; Return to Work - statistics & numerical data; Risk Factors; Sick leave; Sick Leave - statistics & numerical data; Socioeconomic Factors; Surgery; Surveys and Questionnaires; Time Factors; Young Adult
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.12494

Objective To measure the impact of the level of invasiveness of gynaecological procedures on time to full Return to Work (RTW) and to identify the most important preoperative sociodemographic, medical and work‐related factors that predict the risk of prolonged sick leave. Design Prospective cohort study. Setting Dutch university hospital. Population A total of 148 women aged 18–65 years scheduled for gynaecological surgery for benign indications. Methods A questionnaire regarding the surgical procedure as well as perioperative and postoperative complications was completed by the attending resident at baseline and 6 weeks after surgery. All other outcome measures were assessed using self‐reported patient questionnaires at baseline and 12 weeks post‐surgery. The follow‐up period was extended up to 1 year after surgery in women failing to return to work. Surgical procedures were categorised into diagnostic, minor, intermediate and major surgery. Main outcome measures Time to RTW and important predictors for prolonged sick leave after surgery. Results Median time to RTW was 7 days (interquartile range [IQR] 5–14) for diagnostic surgery, 14 days (IQR 9–28) for minor surgery, 60 days (IQR 28–101) for intermediate surgery and 69 days (IQR 56–135) for major surgery. Multivariable analysis showed a strongest predictive value of RTW 1 year after surgery for level of invasiveness of surgery (minor surgery hazard ratio [HR] 0.51, 95% CI 0.32–0.81; intermediate surgery HR 0.20, 95% CI 0.12–0.34; major surgery HR 0.09, 95% CI 0.06–0.16), RTW expectations before surgery (HR 0.55, 95% CI 0.36–0.84), and preoperative functional status (HR 1.09, 95% CI 1.04–1.13). A prediction model regarding the probability of prolonged sick leave at 6 weeks was developed, with a sensitivity of 89% and a specificity of 86%. Conclusions RTW often takes a long time, especially after intermediate and major surgery. This study reveals important predictors for prolonged sick leave and provides a prediction model for the risk of sick leave extending 6 weeks after benign gynaecological surgery in the Netherlands.