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Platinum Priority – Prostate Cancer
Editorial by Matthew T. Gettman on pp. 72–73 of this issue

Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study

By: Anna Plyma , Flaminia Chiesaa, Margaretha Vossb c, Lars Holmbergd e, Eva Johanssonf, Pär Statting h and Mats Lambea d

European Urology, Volume 70 Issue 1, July 2016, Pages 64-71

Published online: 01 July 2016

Keywords: Disability pension, Prostate cancer, Prostatectomy, Retropubic radical prostatectomy, Robot-assisted radical prostatectomy, Return to work, Sick leave, Sweden, Work disability

Abstract Full Text Full Text PDF (882 KB) Patient Summary

Abstract

Background

Robot-assisted radical prostatectomy (RARP) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy (RRP), but it is unclear whether these differences translate into shorter absence from work.

Objective

To investigate short- and long-term rates of work disability following RARP and RRP.

Design, setting, and participants

We conducted a nationwide population-based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden. Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012.

Outcome measurements and statistical analysis

We used Cox regression to calculate time to return to work (RTW, or duration of sick leave) after surgery and used generalised estimating equations to analyse days lost from work (because of sick leave and disability pension) after RTW.

Results and limitations

Men treated with RARP returned to work after a median of 35 d, whereas the corresponding time for RRP was 48 d (p < 0.001). The difference was seen early; within the first month, men treated with RARP returned to work nearly four times faster than men treated with RRP (adjusted relative RTW rate 3.76; 95% confidence interval [CI], 3.04–4.66). During a median of 3.6 yr after return to work, men treated with RARP lost fewer days from work per person-year than men treated with RRP—12 d versus 15 d—but the association was not statistically significant (p = 0.10). The adjusted rate ratio was 1.08 (95% CI, 0.82–1.42). One limitation is the nonrandomised design of this study.

Conclusions

RARP was associated with a faster RTW compared with RRP, but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW.

Patient summary

We compared disease-related absence from work between two surgical methods for the removal of the prostate. Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective.

Take Home Message

In this real-world study, robot-assisted radical prostatectomy was associated with a faster return to work compared with open retropubic radical prostatectomy, but the surgical method did not influence long-term rates of work disability.

Keywords: Disability pension, Prostate cancer, Prostatectomy, Retropubic radical prostatectomy, Robot-assisted radical prostatectomy, Return to work, Sick leave, Sweden, Work disability.

Footnotes

a Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

b Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden

c Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

d Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden

e King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK

f Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden

g Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden

h Department of Urology, Uppsala University Hospital, Uppsala, Sweden

Corresponding author. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77 Stockholm, Sweden. Tel. +46 8 524 823 88; Fax: +46 8 31 49 75.

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