Author: Dr Tony Williams, Consultant Occupational Physician, Working Fit Ltd.
Date: August 2015.
Gynaecological procedures are common. Some 25,000 vaginal repairs, 40,000 hysterectomies and 70,000 D&C procedures are undertaken in England and Wales each year. The variations in return to work times are substantial and bear little relation to the procedure undertaken, the health of the patient, or co-morbidities. There is substantial variation between countries. Advice on return to work times is often based on historical approaches, and much of the advice is inappropriate and unhelpful, such as ‘just lie on the sofa and don’t even lift a kettle for the first twelve weeks’.
Many women having hysterectomies or repairs are middle-aged, and have been relatively inactive for several years. A further period of prolonged inactivity can lead to such deconditioning that they never recover. This can be disastrous for their future health and wellbeing.
The Royal College of Obestricians and Gynaecologists (RCOG) developed guidelines in 2009 specifically to encourage early physical activity and early return to work because of the health benefits. The aim was to standardise the approach nationwide. Each guideline was drafted by a small number of gynaecologists. These were then discussed by a working group that included an anaesthetist, GP, occupational physician (Dr Tony Williams), nurse and patient representative. It was recognised that early activity, particularly walking, was not harmful and would substantially aid recovery. This is specifically encouraged. The lack of evidence base made it difficult to come to robust conclusions about risk, and the gynaecologists admitted that they were unable to give a clear view on for example the risk of a patient lifting a heavy object within a day or two of a vaginal hysterectomy or pelvic floor repair procedure. The guidelines are therefore conservative, and many women can and do return to physical activity including work earlier than indicated.
It is important to appreciate that these guidelines reflect the expected recovery rate for someone in reasonable health who is reasonably fit. Women who are very obese, who have diabetes or heart disease, who smoke, and who are very physically unfit are likely to take longer to recover and may well develop complications such as wound infections. These can substantially delay recovery, by many weeks or even months.