Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
BJOG. 2014 Mar;121(4):487-97. doi: 10.1111/1471-0528.12494. Epub 2013 Nov 19.
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.
Prospective cohort study.
Dutch university hospital.
A total of 148 women aged 18-65 years scheduled for gynaecological surgery for benign indications.
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.
Time to RTW and important predictors for prolonged sick leave after surgery.
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%.
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.
测量妇科手术的侵袭程度对完全重返工作岗位（RTW）时间的影响，并确定术前最重要的社会人口学、医学和与工作相关的因素，这些因素预测病假延长的风险。
前瞻性队列研究。
荷兰大学医院。
总共 148 名年龄在 18-65 岁之间的女性，因良性指征接受妇科手术。
基线时，主治住院医师完成了一份关于手术以及围手术期和术后并发症的调查问卷。所有其他结果测量均在基线和手术后 12 周时使用自我报告的患者问卷进行评估。在手术后未能重返工作岗位的女性中，随访期延长至 1 年。手术程序被分为诊断性、轻微、中等和主要手术。
RTW 时间和手术后病假延长的重要预测因素。
诊断性手术的 RTW 中位时间为 7 天（四分位距 [IQR] 5-14），轻微手术为 14 天（IQR 9-28），中等手术为 60 天（IQR 28-101），主要手术为 69 天（IQR 56-135）。多变量分析显示，手术侵袭程度对术后 1 年 RTW 的预测价值最强（轻微手术的危险比 [HR] 0.51，95%CI 0.32-0.81；中等手术 HR 0.20，95%CI 0.12-0.34；主要手术 HR 0.09，95%CI 0.06-0.16），手术前的 RTW 期望（HR 0.55，95%CI 0.36-0.84）和术前功能状态（HR 1.09，95%CI 1.04-1.13）。开发了一个关于 6 周时延长病假概率的预测模型，该模型的敏感性为 89%，特异性为 86%。
RTW 通常需要很长时间，尤其是在中等和主要手术后。这项研究揭示了病假延长的重要预测因素，并提供了一个预测模型，用于预测荷兰良性妇科手术后 6 周病假延长的风险。
