Review for 10.1186/1471-230X-10-12 (2010)

Reviewer's report
Title:Assessing factors influencing return back to work after cholecystectomy: a
qualitative research
Version: 1Date:2 July 2009
Reviewer: Thue Bisgaard
Reviewer's report:
Regarding the manuscript:
“Assessing factors influencing return back to work after cholecystectomy: a
qualitative research”
Major comments
1. This is a well written article on an important topic, the causes of sick leave
after one of the most often surgical procedures; cholecystectomy.
The design of the study observational. However, and unfortunately, this study is
retrospective in nature and the analysis is based on qualitative analyses. Patients
in the study were recruited from a previous randomised study by one author
group (Arch Surg 2008; 143:371-377). In this study, the authors randomized 257
patients under going cholecystectomy by laparoscopic or open technique.
Patients received no standardized recommendations for convalescense /
returned to normal activity, but were told to resume work and normal activities as
soon as they felt ready to do it. The authors reported nearly 4 weeks of sick leave
in both surgical groups! I wonder why. The fundamental finding of this extremely
long period of convalescense is the background for the present study. It is known
from other parts of the literature than when using short recommendation of
convalescense, eg. 1 or 2 days (Arch Surg. 2001; 136:917-921) duration of
convalescense can be shortened to less than 4-5 days!) So the present study
was the retrospective nature and patients who participated had no preoperative
lrecommendations. The authors wish to analyze or "all aspects that influence the
timing of return to work" after cholecystectomy, but unfortunately the present
study design does not allow this.
2. The authors concluded, that physicians perceive important factors other than
the patients. And so what? What do the authors actually conclude from their
study? What will the authors, based on their finding recommend their patients
undergoing cholecystectomi? Do the authors think that 4 weeks of
convalescense should be recommend for patients under going rutine
cholecystektomy? I think that is an alarming and wrong interpretation.
Minor comments
1. Patients were included after minimum 6 month after cholecystektomy. What
was the range (6-24 months)? At least, 6 month after an operation means
historical data when taking in to consideration that patients should remember
recall the main problems on not taking up normal activities during the first days
after the operation. Why were the patients not included in this analysis one week
after the operation or even more relevant, why was the study not performed in a
prospective manner?
2. The authors mentioned several times “company physicians” – what is that?
3. In the present publication the authors does not give their actual duration of sick
leave for the patients included but refer to the previous mention study with 4
weeks actual sick leave. What was the actual sick leave in the included patients?
4. The authors mentioned “adapted work” in the result section, what is adapted
work?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
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