Cardiovascular diseases such as angina pectoris and aortic valve disease can be effectively treated with coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). These invasive options are generally recommended to the working-age group. On the other hand, less invasive options like transcatheter aortic valve implantation and percutaneous coronary intervention are recommended to older patients. Surgery aims to enable participation in society, improve quality of life, and increase longevity. This review aimed to evaluate return to work time (RTWT), return to work rate (RTWR) and factors influencing return to work in patients who had angina pectoris or aortic valve disease and had undergone CABG or AVR. This will help develop and provide better assistance and treatment to the patients to facilitate RTW.
Electronic databases like Google Scholar, Embase, Medline and CINAHL were used to perform a literature search to find relevant original articles between 1988 to 2018. The risk of bias was minimised by using the software Rayyan for selection. Ultimately, 45 articles representing 39,801 patients treated for AVR or CABG were identified and used for final inclusion into the study. The O'Malley and Arskey framework was used for collating and summarising the data. Research methods, number of studies, their geographical distribution, and RTWR and RTWT were described in a narrative account in the initial step. A numerical summary analysis was also included. This was followed by evaluating the factors that facilitated or restricted the RTW of patients in the next step.
Results: Out of the 39,801 patients, 16% were women, and the mean age was observed to be 56.3 years. The study included patients who had undergone AVR, CABG or both. The mean RTWT was 30 weeks, and about 66.5% of the patients continued with work. A lower likelihood of RTW was seen in patients with comorbidities like chronic obstructive pulmonary disease, diabetes, atrial fibrillation, renal failure and dyspnoea. An early RTW was associated with normalisation of blood pressure before surgery (mean arterial pressure (MAP) ≤90 mmHg), normal serum troponin and high levels of serum magnesium at admission and a shorter extracorporeal pump run time during surgery with a mean of 64.3 min. Out of the 141 CABG patients, 47% were reported to be psychologically depressed before surgery, whereas 61% were depressed after surgery, which negatively impacted RTW.
A longer than expected RTWT is observed in AVR and CABG patients. A majority of them never return to work. The patient's quality of life and financial status is negatively impacted due to failure to RTW. Measures should be taken to deal with depression associated with surgery, to facilitate better RTW.