Return to work following pelvic reconstructive surgery: secondary analysis of Operations and Pelvic Muscle Training in the Management of Apical Support Loss trial


      Patients’ return to work is an important part of surgical counseling and quality of life.


      This study aimed to evaluate the pattern of patients’ return to work and loss of productivity after pelvic reconstructive surgery.

      Study Design

      This was a secondary analysis of the randomized controlled trial Operations and Pelvic Muscle Training in the Management of Apical Support Loss. The primary outcome was return to work defined by the answer to “How many calendar weeks or workdays did you not go to work after the original prolapse surgery?” Furthermore, loss of productivity included hours and days per week worked and discontinuation of paid work because of urogynecologic conditions. Moreover, predictors affecting the timing of return to work and loss of productivity were assessed.


      Here, 180 patients (49%) were working before surgery. Of these patients, half returned to work 35 days after surgery, with 21 (13%) returning to work immediately after surgery and 43 (27%) returning to work within ≤2 weeks. The number of days missed did not differ between patients who underwent sacrospinous ligament fixation and those who underwent uterosacral ligament suspension (P=.23). At 3 months, 15 patients (9%) who were working before surgery had stopped working, but those who continued to work had similar hours per week as before surgery (36±12 vs 35±13; P=.48). Of note, 17 patients (11%) reported being less productive, on average working at 60% effectiveness. Most patients (96%) reported not missing any hours of household chores by 3 months after surgery. Patients who returned to work within 6 weeks had a higher rate of retreatment with either pessary or surgery within 2 years (5 of 85 [6.8%] vs 0 of 76 [0%]; P=.03). Those who returned to work within 2 weeks worked fewer hours before surgery (30±15 vs 36±12; P=.013), were less likely to have private insurance (77% vs 91%; P=.03), and had a higher rate of retreatment (3 of 30 [13%] vs 2 of 131 [1.7%]; P=.007). There was no difference in bulge symptoms and anatomic failure based on return to work.


      Most patients returned to work within 35 days after surgery. Working less than full time and not having private insurance were predictors of earlier return to work.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Reed P.
        The medical disability advisor: the most comprehensive trusted resource for workplace disability duration guideline.
        5th ed. Reed Group Ltd, Westminster, CO2006
        • Barber M.D.
        • Brubaker L.
        • Burgio K.L.
        • et al.
        Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial.
        JAMA. 2014; 311: 1023-1034
        • Barber M.D.
        • Brubaker L.
        • Menefee S.
        • et al.
        Operations and pelvic muscle training in the management of apical support loss (OPTIMAL) trial: design and methods.
        Contemp Clin Trials. 2009; 30: 178-189
        • Dietz V.
        • Van Der Vaart C.H.
        • Van Der Graaf Y.
        • Heintz P.
        • Schraffordt Koops S.E.
        One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study.
        Int Urogynecol J. 2010; 21: 209-216
        • Heit M.
        • Carpenter J.S.
        • Chen C.X.
        • Rand K.L.
        Operationalizing postdischarge recovery from laparoscopic sacrocolpopexy for the preoperative consultative visit.
        Female Pelvic Med Reconstr Surg. 2021; 27: 427-431
        • Winkelman W.D.
        • Erlinger A.L.
        • Haviland M.J.
        • Hacker M.R.
        • Rosenblatt P.L.
        Survey of postoperative activity guidelines after minimally invasive gynecologic and pelvic reconstructive surgery.
        Female Pelvic Med Reconstr Surg. 2020; 26: 731-736
        • Vonk Noordegraaf A.
        • Anema J.R.
        • Louwerse M.D.
        • et al.
        Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands.
        BJOG. 2014; 121: 487-497
        • Evenson M.
        • Payne D.
        • Nygaard I.
        Recovery at home after major gynecologic surgery: how do our patients fare?.
        Obstet Gynecol. 2012; 119: 780-784
        • Kleim B.D.
        • Malviya A.
        • Rushton S.
        • Bardgett M.
        • Deehan D.J.
        Understanding the patient-reported factors determining time taken to return to work after hip and knee arthroplasty.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3646-3652
        • Wright A.P.
        • Berridge D.C.
        • Scott D.J.
        Return to work following varicose vein surgery: influence of type of operation, employment and social status.
        Eur J Vasc Endovasc Surg. 2006; 31: 553-557
        • Vergeldt T.F.
        • Weemhoff M.
        • IntHout J.
        • Kluivers K.B.
        Risk factors for pelvic organ prolapse and its recurrence: a systematic review.
        Int Urogynecol J. 2015; 26: 1559-1573
        • Mueller M.G.
        • Lewicky-Gaupp C.
        • Collins S.A.
        • Abernethy M.G.
        • Alverdy A.
        • Kenton K.
        Activity restriction recommendations and outcomes after reconstructive pelvic surgery: a randomized controlled trial.
        Obstet Gynecol. 2017; 129: 608-614