Fitness for work after surgery or critical illness

Tony Williams and Bill Thomas

Introduction

Occupational health practitioners are frequently asked for advice on fitness to return to work after surgery. Providing the best answer is not always clear cut, as there is little evidence and a great deal of misunderstanding among patients and clinicians. One patient may be back at work within a week of a hysterectomy while another insists she is not fit to return after 5 months. There are medical issues here, but these are often confounded by inappropriate beliefs, unhelpful motivators, and uneducated advice.

Perhaps the problem is best illustrated in a simple study published in the British Medical Journal in 1995. Majeed et al.1 asked 100 general surgeons and 90 GPs to recommend time off work for patients aged 25 or 55 years in sedentary, light manual, and heavy manual roles. The answers varied so widely that it was apparent that those giving advice had no full understanding of the issues. For example, after unilateral inguinal hernia repair in a 25-year-old returning to heavy manual work, surgeons’ recommendations varied from 1 to 12 weeks, and GP recommendations varied from 2 to 13 weeks.

Often, however, there is a limitation in the evidence base. An expert working group, attempting to develop guidelines for the Royal College of Obstetricians and Gynaecologists (RCOG), found it easy to agree that a woman who had a vaginal hysterectomy would probably be at risk from heavy lifting within the first 4 weeks because of the nature of the surgery undertaken, but found no empirical evidence to support this. It is therefore difficult to quantify the actual risk and the advice finally given by the group was to adapt a 4-week cut off point. This represented a substantial shift from the 12 weeks not uncommonly recommended but in the absence of evidence to the contrary, it was considered that this was the best advice that could be provided.

 
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