Return to work after mid-urethral sling: secondary analysis of the trial of mid-urethral slings

Abstract

The timing for returning to work is an important part of surgical counseling and quality of life. Objective: To evaluate the pattern of patients returning to work and return to normal daily life following mid-urethral sling surgery. Methods: This is a secondary analysis of the randomized controlled Trial of Mid-Urethral Slings (TOMUS), a two-arm randomized controlled trial that compared two types of mid-urethral slings used for the treatment of stress urinary incontinence: the retropubic mid-urethral sling and the transobturator mid-urethral sling. Our primary outcome is timing of return to work and normal activities as defined by the answer to Have you returned to full normal activities of daily life (including work, if applicable) since your surgery? Secondary outcomes included paid days off, number of days to return to normal daily life, and objective and subjective failures. Patients who underwent a concomitant surgery were excluded. Predictors affecting the timing of return to work and normal activities were also assessed. Given multiple comparisons, Bonferroni correction with threshold at 0.003 was used to assess the statistical significance of p-values. Results: Among patients undergoing a mid-urethral sling, 183 (41.5%) returned to normal activities within 2 weeks. Within 6 weeks of surgery, 308 (70.0%) had returned to normal activities including work. At the 6 months follow up, 407 (98.3%) had returned to normal activities including work. Patients took a median of 14 days (interquartile range 1-115 days) to return to normal activities including work and took a median of 5 (interquartile range 0-42 days) paid workdays off. Those who returned within 2 weeks versus after 2 weeks did not have significantly different characteristics after accounting for multiple comparisons. Rates of objective failure, subjective failure, and complications were not significantly different between those who returned within 2 weeks and those who returned after 2 weeks. In multivariate regression analysis, there was no significant predictor of the timing of returning to normal activity/work. Conclusions: Less than half of patients returned to work and normal activities within 2 weeks of a mid-urethral sling surgery. The timing of return to work was not associated with significant differences in treatment failure or adverse outcomes.