Article

Factors affecting return to work after carpal tunnel syndrome surgery in a large French cohort.

Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, France.
Archives of physical medicine and rehabilitation (Impact Factor: 2.18). 11/2011; 92(11):1863-9. DOI: 10.1016/j.apmr.2011.06.001
Source: PubMed

ABSTRACT To evaluate occupational outcomes after surgical release of the median nerve in carpal tunnel syndrome (CTS).
Retrospective study 12 to 24 months after surgery.
Hand centers (N=3) in 2 different areas.
Patients who had undergone surgical release of the median nerve in 2002 to 2003.
Not applicable.
Duration of sick leave after surgery and associated factors were analyzed by using bivariate (log rank) and multivariate analyses of survival (Cox model).
Questionnaires mailed in 2004 regarding medical condition (history and surgery), employment (occupational category codes in 1 digit), and compensation were returned (N=1248; 62%), with 253 men and 682 women stating they were employed at the time of surgery (N=935). Most were working at the time of the study (n=851; 91.0%). Median duration of sick leave before returning to work was 60 days. The main factors associated with adverse occupational outcome (long duration of sick leave) were simultaneous intervention for another upper-extremity musculoskeletal disorder, belief (by the patient) in an occupational cause, and "blue-collar worker" occupational category (the strongest determinant).
This study emphasizes the multifactorial nature of the occupational outcome of CTS after surgery, including occupational category. The probability of return to work for each risk factor provides a fair description of prognosis for physicians and patients.

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    ABSTRACT: Introduction Surgery of the forefoot including the hallux involves procedures on one bone or more. Usually bone union occurs within 45 days after surgery. During convalescence, the patient can gradually return to his/her activities. The duration of sick leave (SL) can be used to evaluate the influence of convalescence on professional life. The goal of this study was to evaluate the influence of the socioprofessional category (SPC) on the duration of SL after surgery of the forefoot including the hallux. Patients and methods This was a single center, single surgeon prospective cohort study performed between January 2012 and March 2013. It included working patients over 18 who underwent hallux surgery associated or not with surgery of the lateral rays. A standardized questionnaire was filled out during the postoperative day 45 consultation to determine factors that could influence the duration of sick leave. Regression models (Cox model) were used to indentify variables associated with the duration of sick leave. Results Among the operated patients, 102 were included and divided into 5 SPC. SL lasted a mean 45 days (from 8 to 90 days). The only predictive factors for the duration of SL on multivariate analysis using SPC 2 as a reference were SPC and the VAS (Visual Analogue Scale). The mean duration of SL was 15 days for SPC 2, 35 days for SPC 3, 47 days for SPC 4, 50 days for SPC 5 and 67 days for SPC 6. Discussion–Conclusion The distribution of SPC was comparable to that of the working population in the Île de France. The SPC appears to be a predictive factor for the duration of SL after hallux surgery. Severe pain seems to increase the duration of SL. Surgeons and patients should be informed accordingly. Level of evidence Level IV.
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