title: Duration of sick leave after shoulder arthroscopy in Germany: analysis of health care data.
abstract: BACKGROUND
  The expected duration of incapacity after arthroscopic shoulder surgery is an important factor for therapy planning. The aim of this study was to analyze the duration of sick leave after arthroscopic shoulder surgery in Germany and to identify factors associated with a longer duration of sick leave. We hypothesized that certain patient-related factors may be associated with a longer duration of sick leave.
  
  
  METHODS
  Routine health care data of all patients insured by one German health insurance company who underwent inpatient arthroscopic shoulder surgery between 2010 and 2012 were included in the analysis of the duration of sick leave in this retrospective cohort study (level III evidence). Comparisons were performed for different arthroscopic surgical procedures using the log-rank test. Possible factors that might be associated with a longer duration of incapacity were analyzed.
  
  
  RESULTS
  Sick leave was reported in 303 of 660 cases. The median duration of sick leave was 82 days after subacromial decompression and 157 days after rotator cuff repair (p = 0.004). The duration of sick leave was longer in patients older than 50 years (p = 0.044) and in patients with sick leave that started prior to surgery (p < 0.001). Patients not receiving physiotherapy had a longer period of sick leave (p = 0.058). The median period of prescribed physiotherapy (64 days) was shorter than the period of incapacity. The duration of disability was not notably longer in female patients, patients taking opioid or antidepressant medication or diabetics.
  
  
  CONCLUSIONS
  The duration of sick leave after arthroscopic shoulder surgery in Germany does not exceed sick leave duration in other countries. More complex procedures, advanced age and sick leave beginning prior to surgery resulted in longer durations of sick leave. Preoperative prognosis of the necessary duration of postoperative sick leave may not always be realistic. An extended period of sick leave can be expected after more complex procedures and in patients older than 50 years of age. Future studies should investigate whether a longer period of physiotherapy may help to shorten the period of postoperative sick leave.
authors.affiliation: Department of Shoulder Surgery, Kreiskrankenhaus Osterholz, Am Krankenhaus 4, 27711, Osterholz-Scharmbeck, Germany. mariusvonknoch@yahoo.com.|Department of Shoulder Surgery, AMEOS Klinikum Seepark Geestland, Geestland, Germany. mariusvonknoch@yahoo.com.
authors.forename: Marius
authors.initials: M
authors.lastname: von Knoch
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Enders
authors.affiliation: AOK Bremen/Bremerhaven, Bremen, Germany.
authors.forename: Natasha I
authors.initials: NI
authors.lastname: Schlothauer
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Goettingen, Goettingen, Germany.
authors.forename: Hans Michael
authors.initials: HM
authors.lastname: Klinger
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Pigeot
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001182:Arthroscopy; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011182:Postoperative Care; D012189:Retrospective Studies; D012782:Shoulder / Q000601:surgery*; D018582:Sick Leave / Q000706:statistics & numerical data*
keywords: Arthroscopy; Germany; Routine data; Shoulder; Sick leave