Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Appendectomy


Related Terms

  • Excision of Appendix
  • Removal of the Appendix

Specialists

  • General Surgeon

Comorbid Conditions

  • Cardiovascular disease
  • Gastrointestinal disorders
  • Hepatic disease
  • Immune system disorders
  • Obesity
  • Renal disease

Factors Influencing Duration

The type of surgery, the surgeon's skill, presence of surgical complications, and condition of the appendix (i.e., intact, abscessed, ruptured) may affect recovery time. Those who perform heavy work may require a longer recovery period than those with more sedentary tasks.

Medical Codes

ICD-9-CM:
47.01 - Laparoscopic Appendectomy
47.09 - Appendectomy, Other
47.11 - Laparoscopic Incidental Appendectomy
47.19 - Other Incidental Appendectomy

Overview

An appendectomy is the surgical removal of the vermiform appendix, a small, finger-shaped projection in the lower right abdomen at the juncture of the large and small intestines. The appendix, which protrudes from a section of the large intestine (cecum), generally has been considered an unessential organ that is removable without significant loss of body function. Nevertheless, it is part of the gut-associated lymphoid tissues (GALT), important tissue where immune responses are initiated. The appendix produces a small amount of mucus that normally flows into the large intestine.

Symptoms such as severe abdominal pain accompanying an inflamed and infected appendix tend to occur rapidly (acute). For this reason, an appendectomy usually is an emergency procedure.

Source: Medical Disability Advisor



Reason for Procedure

Appendectomy is performed as treatment for infection and inflammation of the appendix (appendicitis). Due to the nature of the signs and symptoms of acute appendicitis, the diagnosis is never certain until the appendix is inspected during open or laparoscopic surgery. In 18.3% of cases of suspected appendicitis, the removed appendix is free of disease (Ekeh). Due to the recognition of the importance of the appendix in the immune system, the practice of removing a healthy appendix in the course of other abdominal surgery to prevent future inflammation and infection, thus possibly sparing the individual a future emergency surgery, is being abandoned.

Source: Medical Disability Advisor



How Procedure is Performed

Appendectomy is done by a general surgeon as an inpatient surgery under general anesthesia. The surgery may be performed using an open incision or via laparoscopy.

During a traditional open appendectomy, a small incision (McBurney incision) is made in the abdominal wall. The incision is made in the lower right side of the abdomen, in the area over the appendix, and the muscles over the appendix are split or cut. The surgeon then locates the appendix and inspects it. If there are no complications involving the surrounding tissues, the surgeon separates (dissects) the appendix from the abdomen and / or large intestine and then cuts its attachment to the cecum, removing the appendix. The cecum is then closed with sutures. If a pocket of infection (abscess) has formed, it will be cleansed and suctioned away by a special instrument (suction irrigator). A tube also may be inserted into the abdomen to promote drainage from the infected site. The abdominal incision is then closed, and the procedure is complete.

In most cases, surgeons choose a laparoscopic procedure to remove the appendix in which a tiny video camera (laparoscope) is inserted into the abdomen through a very small incision. During the laparoscopic procedure, the surgeon uses the video camera to view the abdominal cavity and its contents. Because abdominal regions can be seen easily, this technique is especially useful when the diagnosis of appendicitis is unclear. Specialized surgical tools that can be inserted through tiny incisions are used to remove the appendix in the same manner as for the conventional open surgical procedure. Although the laparoscopic approach can take longer to perform, the benefits of laparoscopic surgery include less postoperative discomfort and quicker recovery time. In the case of a ruptured or perforated appendix, the open incision method may be preferred because it is associated with fewer incidences of postoperative abdominal abscesses.

With open or laparoscopic appendectomy, if the appendix has ruptured (perforated appendix), the surgeon flushes the spilled material (pus) from the abdomen with sterile warm water, and a drain is inserted and left in place to promote drainage of infected fluids.

Source: Medical Disability Advisor



Prognosis

Laparoscopic appendectomy is successful in up to 94% of uncomplicated cases, and in 90% of cases in which the appendix has ruptured (Craig). Deaths following an uncomplicated appendectomy are rare, with an overall mortality rate after appendectomy of less than 1% (Townsend). Mortality following appendectomy is strongly correlated with age, with a death rate of 0.07 per 1,000 individuals aged 20 to 29, and 164 per 1,000 individuals aged 90 and above (Townsend).

Source: Medical Disability Advisor



Complications

The rate of complications following open surgery is similar to that following laparoscopic appendectomy (Santacroce). Potential complications of appendectomy include infection of the surgical incision or abdominal cavity (peritonitis), abscess, bleeding, formation of abdominal scar tissue (adhesions), and blockage of the intestines (bowel obstruction). As with any surgery performed under general anesthesia, complications also may include pneumonia and the formation and dislodging of blood clots (thromboembolism). Instruments used to cut the appendix away from the intestine can perforate the intestine or the tube (ureter) carrying urine from kidney to the bladder. If the individual being treated is pregnant, an appendectomy may lead to premature labor and delivery.

Individuals with a ruptured appendix (perforated appendicitis) prior to surgery can develop infection of the abdominal cavity (peritonitis), which may be life threatening. Perforated appendicitis may lead to postoperative development of abdominal abscesses, which are more prevalent if laparoscopic surgery is used. For removal of an appendix that has not ruptured, the complication rate is 3%. If the appendix has ruptured, the complication rate approaches 59% (“Appendectomy”).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Following an uncomplicated appendectomy, most individuals are discharged from the hospital within 1 day after the surgery ("Appendectomy"). Activity will be limited for 1 to 3 weeks, but full recovery should be expected within 4 to 6 weeks (Swierzewski). An individual with a ruptured appendix may be hospitalized for at least 4 days following surgery (Swierzewski). Individuals with complications also can expect full recovery, although the recovery period may be prolonged.

Following appendectomy, temporary restrictions on lifting (not greater than 25 pounds [11 kg] for 6 weeks) and heavy physical labor may be necessary until recovery is complete. If pain medication is needed, company policy on medication use should be reviewed to determine if medication usage is compatible with job safety and function.

Source: Medical Disability Advisor



References

Cited

"Appendectomy." Surgery.com. 14 Aug. 2009 <http://www.surgery.com/procedure/appendectomy>.

Craig, Sandy. "Appendicitis, Acute." eMedicine. Eds. William Lober, et al. 1 Jun. 2009. Medscape. 14 Aug. 2009 <http://emedicine.medscape.com/article/773895-overview>.

Ekeh, Akpofure Peter, et al. "Laparoscopy in the Contemporary Management of Acute Appendicitis." American Journal of Surgery 193 3 (2007): 310-313. PubMed. <PMID: 17320525>.

Santacroce, Luigi, and Juan B. Ochoa. "Appendicitis." eMedicine. Eds. Oscar Joe Hines, et al. 1 May. 2009. Medscape. 14 Aug. 2009 <http://emedicine.medscape.com/article/195778-overview>.

Swierzewski, Stanley J. "Appendectomy." Surgery Channel. 1 Nov. 2001. Healthcommunities.com. 14 Aug. 2009 <http://www.surgerychannel.com/appendectomy/index.shtml>.

Townsend, Courtney M., et al. "Chapter 16: Surgery in the Elderly: Specific Considerations in Gastrointestinal Surgery." Sabiston Textbook of Surgery. 18 ed. Elsevier Saunders, 2008. MD Consult. Elsevier, Inc. <http://www.mdconsult.com/das/book/body/154340464-3/875115884/1565/157.html#4-u1.0-B978-1-4160-3675-3..50020-4--cesec36_782>.

Source: Medical Disability Advisor






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