Author: Dr Tony Williams, Consultant Occupational Physician, Working Fit Ltd.
Date: August 2015.
In 1995 a study published in the BMJ asked 100 general surgeons and 90 GPs to recommend time off work for notional patients aged 25 or 55 years. They considered four different conditions, against sedentary, light manual and heavy manual roles. The answers varied widely; for example after unilateral inguinal hernia repair in a 25-year old returning to heavy manual work surgeons recommendations varied from one to twelve weeks, GP recommendations varied from two to thirteen weeks (Majeed et al., 1995).
The only conclusion that can be drawn is that most surgeons and GPs don’t actually know or understand how long people need off work after surgery, even those doing the operation. Any sick note or advice given should be viewed with caution.
A study of return to work of 50 consecutive patients after carpal tunnel release found that surgeon’s recommendations for return to work varied from 1 to 36 days, and actual time to return to work varied from 1 to 88 days. Although the surgeons appeared to relate advice to the nature of work, this was not highly predictive. The duration of actual absence from work was not related to the severity of symptoms before or after surgery. The factor that had the strongest influence on duration of absence was the surgeon’s recommendation (Ratzon et al., 2006).
This suggests that patients will follow the advice given by their surgeon even if it is clearly wrong. We would expect patients to follow their surgeon’s advice, so this can be a very difficult issue to address. It is particularly when an occupational health professional with expertise in advising on return to work after surgery who knows the right answers is faced with an employee wishing to stay off work for, say, twelve weeks. They could return after two and would benefit from the rehabilitative effect of work. A middle aged employee who was not particularly fit before surgery may lose substantial fitness and gain substantial weight if they remain off work for twelve weeks doing no activity. It can then be extremely difficult for them to reverse this deconditioning and regain fitness afterwards.
Part of the solution is to help surgeons and GPs provide the correct advice (and it is hoped this website will assist with this). Careful advice and explanation from occupational health professionals will also help, along with pragmatic support from management.
There is a good evidence base for long term recovery after surgery (for example return to sport after hip replacement) but very limited evidence base in relation to the timeline for recovery. We know what the eventual outcome will be, but not when they will be able to sit comfortably at a desk, stand for a full shift, squat, walk a mile or lift a 25kg load. There are, however, good general principles of wound healing that can be applied, along with common sense.
MAJEED, A. W., BROWN, S., WILLIAMS, N., HANNAY, D. R. & JOHNSON, A. G. 1995. Variations in medical attitudes to postoperative recovery period. BMJ, 311, 296.
RATZON, N., SCHEJTER-MARGALIT, T. & FROOM, P. 2006. Time to return to work and surgeons' recommendations after carpal tunnel release. Occup Med (Lond), 56, 46-50.