title: Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study.
abstract: 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.
  
  
  
  To investigate short- and long-term rates of work disability following RARP and RRP.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: anna.plym@ki.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Plym
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Flaminia
authors.initials: F
authors.lastname: Chiesa
authors.affiliation: Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Margaretha
authors.initials: M
authors.lastname: Voss
authors.affiliation: Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden; King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.affiliation: Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.affiliation: Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden; Department of Urology, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
mesh_terms: D015331:Cohort Studies; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D062707:Return to Work / Q000706:statistics & numerical data*; D065287:Robotic Surgical Procedures; D018582:Sick Leave / Q000706:statistics & numerical data*; D013548:Sweden; D013997:Time Factors
keywords: Disability pension; Prostate cancer; Prostatectomy; Retropubic radical prostatectomy; Return to work; Robot-assisted radical prostatectomy; Sick leave; Sweden; Work disability