Relationship between health status and postoperative return to work

Time back to work or normal activity is often regarded as an outcome measure of interest after surgery. It has recently been used as a way of quantifying the benefits of minimal access surgery. However, the extent to which variation in time back to normal reflects differences in health status is unclear.

The relationship was examined in 140 patients recovering from inguinal hernia repair. A multi-dimensional measure of health status, the Short Form 36 (SF-36), was administered preoperatively, and at ten days and six weeks postoperatively. The relationship between scores on the SF-36 dimensions and return to normal activity was examined using correlation statistics and stepwise regression.

Health status dimensions measuring role limitation owing to physical restriction at 10 days and 6 weeks, and role limitation owing to mental problems at ten days were associated with time to return to normal on univariate analysis. Social class was also strongly associated. Using stepwise regression these two dimensions of health status together explained 33 per cent of the variance in time to normal. Other factors unrelated to health status clearly contributed to this outcome.

Time back to normal activity postoperatively is influenced by a number of factors unrelated to health status and is an unreliable proxy for it. Time to normal is therefore, not a good outcome measure for quantifying the benefits of surgical interventions. Claims currently being made to justify investment in some minimal access interventions should be interpreted in the light of this.