The table has been compiled by Dr Tony Williams from evidence in a number of publications and from consensus among surgeons specialising in the various procedures.  There are a number of important points to note in relation to the table.

Recommendations based on formal analysis of evidence are in red.  Where only some evidence is available, the figures are in blue, and the relevant references are provided.  Consensus-based guidelines are in black.  Consensus guidelines were mostly developed from studies carried out in the South West of England, with some additional guidelines from NHS Greater Glasgow and Clyde. Where there was a significant difference of opinions the range is included.  Guidelines included in Fitness for Work are regarded as consensus guidelines unless referenced evidence was included.

The Royal College of Surgeons of England and the Royal College of Obstetricians and Gynaecologists have recently published guidelines for a number of specific procedures. These are available on their website and are considered consensus-based guidelines. Dr Tony Williams represented the Faculty of Occupational Medicine and Society of Occupational Medicine as a member of the steering groups that produced these guidelines.

There are a number of myths and traditions associated with prolonged recovery times after surgery.  Where it has been ‘accepted practice’ to recommend prolonged times off work this is rarely to the benefit of the patient who is likely to suffer significant deconditioning and find it much harder to settle back into normal work afterwards.  Unnecessary delay returning to work can lead to loss of employment.  Work is good for physical and mental health; being out of work has negative effects on health and leads to health inequalities and social exclusion and this impacts on families as well as individuals.

Physical fitness plays a major role in the speed of recovery after surgery, and resting for too long can result in substantial physical deconditioning coupled with weight gain. Patients who feel unable to return to work should still be encouraged to exercise daily to improve their fitness and avoid gaining weight. Walking is safe after most surgical procedures, and for those unsure of how much to walk, buying a cheap pedometer will help them monitor their activity and their recovery.

With modern surgical techniques many patients are fit to return to work within days or at most a few weeks after surgery.  Surgical techniques do differ, so individual surgeons may recommend slightly different times off work.

The times given generally represent maximum times likely to be needed for recovery.  Many patients will be safe to return to work sooner.

Most methods of closure are strong and resistant to damage.  For example after inguinal hernia repair individuals will not be harmed by undertaking physical activity immediately after surgery although they will experience significant discomfort. 

In a few cases when individuals may be fit to return to work sooner, they may need to avoid certain heavy manual handling tasks for a little longer.  It is rarely necessary to advise against work in these circumstances.  Advice would normally be to undertake all the other activities at work but avoid only those tasks that will put the patient at risk.

Motivation has a major effect on recovery after surgery.  Patients who have clearly been motivated and have adhered to a comprehensive rehabilitation programme would be expected to return earlier.  Patients do not need to wait until they are symptom free and 100% fit before resuming work.  They should be allowed to accept some discomfort initially as they regain fitness.

Where GPs are unsure of the nature of work or of the risk to the patient returning to a particular role and there is an occupational health service available, GPs should recommend referral to occupational health for specific advice.

Patients would only be expected to take longer to recover than the times recommended below if there are significant complications with the procedure.  Early wound infection treated promptly with antibiotics is unlikely to delay return to work.  A complication such as wound dehiscence is likely to delay return.

The tables have been compiled primarily to support clinicians advising patients returning to work. If practitioners are aware of evidence published in a peer-reviewed journal that can add to or amend these tables please email us at Working Fit.

Table compiled by Dr Tony Williams, Consultant Occupational Physician, Working Fit Ltd and Medway Maritime NHS Foundation Trust