Return to work following pelvic reconstructive surgery: secondary analysis of operations and pelvic muscle training in the management of apical support loss (optimal)

Abstract

To evaluate patients' return to work and loss of productivity following pelvic reconstructive surgery. This is a secondary analysis of the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial. The primary outcome is number of work days missed following surgery. Loss of productivity included hours worked per week and discontinuation of paid work. Predictors affecting the timing of return to work were assessed. In the trial, 180 (49%) of patients worked at baseline reporting 35±13 hours per week. The median number of days missed following surgery was 35 (range 0-210 days). Among these, 21 (13%) did not miss any work days, 43 (27%) missed two weeks or less, and 130 (81%) missed 6 weeks or less. Return to work did not differ between patients who underwent sacrospinous ligament fixation (SSLF) vs. uterosacral ligament suspension (USLS) (P=0.23) (Figure 1). At 3 months, 15 (9%) of patients who were working before surgery had stopped working, and 17 (11%) of patients who were working reported being about 40% less productive for a median of 4 days per month. Most patients (96%) reported not missing any hours of housework by 3 months. Comparing patients who missed ≥6 weeks, those who missed <6 weeks had a higher rate of retreatment with pessary/surgery within 2 years (6.8% vs. 0%, P=0.03) (Table 1). Comparing patients who missed <2 weeks to ≥2 weeks, the former worked 6-8 fewer hours prior to and following surgery (P values <0.05), were less likely to have private insurance (77% vs. 91%, P=0.03), and had a higher rate of retreatment (13% vs. 1.7%, P=0.007). Half of patients returned to work <5 weeks following pelvic reconstructive surgery. There was no difference between those who underwent USLS vs. SSLF. Working less than full time and not having private insurance were predictors of earlier return to work, and those who returned to work earlier had higher rates of retreatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)