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

ObjectiveTo 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. DesignProspective cohort study. SettingDutch university hospital. PopulationA total of 148 women aged 18-65years scheduled for gynaecological surgery for benign indications. MethodsA questionnaire regarding the surgical procedure as well as perioperative and postoperative complications was completed by the attending resident at baseline and 6weeks after surgery. All other outcome measures were assessed using self-reported patient questionnaires at baseline and 12weeks post-surgery. The follow-up period was extended up to 1year after surgery in women failing to return to work. Surgical procedures were categorised into diagnostic, minor, intermediate and major surgery. Main outcome measuresTime to RTW and important predictors for prolonged sick leave after surgery. ResultsMedian time to RTW was 7days (interquartile range [IQR] 5-14) for diagnostic surgery, 14days (IQR 9-28) for minor surgery, 60days (IQR 28-101) for intermediate surgery and 69days (IQR 56-135) for major surgery. Multivariable analysis showed a strongest predictive value of RTW 1year 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 6weeks was developed, with a sensitivity of 89% and a specificity of 86%. ConclusionsRTW 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 6weeks after benign gynaecological surgery in the Netherlands.