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.

Hysterectomy


Related Terms

  • Excision of the Uterus
  • Laparoscopic-assisted Abdominal Hysterectomy
  • Laparoscopic-assisted Vaginal Hysterectomy
  • LAVH
  • Partial Hysterectomy
  • Supracervical Hysterectomy
  • TAH-BSO
  • Total Abdominal Hysterectomy
  • Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy
  • Total Laparoscopic Hysterectomy
  • Vaginal Hysterectomy

Specialists

  • General Surgeon
  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

Length of disability may be influenced by the individual's age, the underlying cause for the hysterectomy, the type of hysterectomy (partial, total, radical), the approach (abdominal, vaginal, laparoscopic), and the severity of any postoperative complications.

Medical Codes

ICD-9-CM:
68.31 - Laparoscopic Supracervical Hysterectomy [LSH]; Classic Infrafascial SEMM Hysterectomy [CISH]; Laparoscopically Assisted Supracervical Hysterectomy [LASH]
68.39 - Subtotal Abdominal Hysterectomy, NOS, Other; Supracervical Hysterectomy
68.41 - Laparoscopic Total Abdominal Hysterectomy; Total Laparoscopic Hysterectomy [TLH]
68.49 - Other and Unspecified Total Abdominal Hysterectomy; Hysterectomy: Extended
68.51 - Laparoscopically Assisted Vaginal Hysterectomy (LAVH)
68.59 - Vaginal Hysterectomy, Other and Unspecified
68.61 - Laparoscopic Radical Abdominal Hysterectomy; Laparoscopic Modified Radical Hysterectomy; Total Laparoscopic Radical Hysterectomy [TLRH]
68.69 - Other and Unspecified Radical Abdominal Hysterectomy; Modified Radical Hysterectomy; Wertheims Operation
68.71 - Laparoscopic radical vaginal hysterectomy [LRVH]
68.79 - Radical Vaginal Hysterectomy, Other and Unspecified; Hysterocolpectomy; Schauta Operation
68.9 - Hysterectomy, Other and Unspecified; Hysterectomy NOS

Overview

Hysterectomy is the surgical removal of the uterus; the cervix, ovaries, fallopian tubes and other surrounding structures may be removed at the same time.

Hysterectomy is the second most common major surgical procedure performed in the US; 600,000 women undergo hysterectomy annually (ACOG). Types of hysterectomy include partial or supracervical hysterectomy, in which the upper part of the uterus is removed but the cervix is left intact; total (or complete) hysterectomy, in which the uterus and cervix are removed; and radical hysterectomy, in which the uterus, cervix, upper part of the vagina, and some surrounding tissue and lymph nodes are removed. A radical hysterectomy is the most extensive surgery and is indicated in certain forms of cancer, including cancer of the cervix. A total hysterectomy with bilateral salpingo-oophorectomy involves removal of the uterus, cervix, fallopian tubes, and ovaries. Removal of the ovaries initiates induced menopause in premenopausal women.

Source: Medical Disability Advisor



Reason for Procedure

The primary reasons to perform a hysterectomy are large, painful, or excessive fibroid tumors in the muscle tissue of the uterus (40%); endometriosis, a condition in which cells from the uterine lining migrate outside of the uterine cavity (17.7%); loss of pelvic muscle support (uterine prolapse) severe enough to interfere with bowel or bladder function (14.5%); or abnormally heavy, prolonged, or frequent uterine bleeding (menorrhagia) extreme enough to cause anemia that cannot be controlled by medication and hormones (10%) (ACOG; Parker). All types of hysterectomy end menstruation and a woman's ability to become pregnant.

If medical therapies (e.g., hormone therapy, anti-inflammatory medication, or analgesics) have not effectively addressed symptoms affecting women's lives, a hysterectomy may be indicated in other non-emergency situations such as recurrent pelvic infection (i.e., bacterial infection of fallopian tubes and ovaries), and widespread buildup of extra tissue that normally lines the uterus (endometrial hyperplasia) .

Hysterectomy is indicated for emergency or urgent situations such as cancer of the vagina, cervix, uterus, fallopian tubes, or ovaries; severe, uncontrollable bleeding; severe, uncontrollable infection; and procedures requiring removal of the uterus in order to treat life-threatening conditions affecting other organs.

Source: Medical Disability Advisor



How Procedure is Performed

Hysterectomy is a major surgical procedure that almost always requires hospitalization. Prior to surgery, a series of tests are performed to evaluate general health and to rule out the presence of infection or anemia; routine diagnostic tests include a complete blood count (CBC), urinalysis, chest x-ray, and electrocardiogram (ECG) (for individuals over age 35 years).

Hysterectomies are performed in an operating room under general anesthesia. Surgeons have many options to consider such as surgical approach, organs to be removed besides the uterus, blood vessels that require ligation during surgery, and whether to perform partial or total procedures. Hysterectomy procedures can be performed through vaginal access, abdominal wall incisions, or small laparoscopic incisions. The access method is determined by anatomic factors such as size of the uterus, patient preference, and the nature and severity of the underlying condition.

A vaginal approach is usually performed on individuals who also require bladder or vaginal repair, and when the uterus is not too large.

Open abdominal approaches, using either horizontal or vertical abdominal incisions, are used in the presence of pelvic inflammatory disease, tissue scarring from previous pelvic surgery (adhesions), endometriosis, or when a uterus is abnormally large or uterine mobility is lacking.

Laparoscopic hysterectomies involve a tiny abdominal incision and the use of laparoscopic tools that pass through a narrow, lighted tube into the surgical area; they are considered less invasive. One advantage is the ability to view the surgical procedure on a monitor by using a small laparoscopic telescoping device with a camera; however, the laparoscopic approach is associated with more complications and increased operating time.

Each type of surgery takes between 1 and 3 hours to perform. Laparoscopic-assisted abdominal procedures take up to an hour longer than other procedures. Vaginal hysterectomy, when feasible, is the safest and most cost-effective procedure; however, abdominal hysterectomy is chosen in 66% of cases, vaginal hysterectomy in 22% of cases, and laparoscopic hysterectomy in 12% of cases (ACOG).

A laparoscopic-assisted vaginal hysterectomy (LAVH) combines a laparoscopic procedure requiring two or three small abdominal incisions with a vaginal wall incision. Similarly, a laparoscopic-assisted abdominal hysterectomy combines laparoscopic incisions with a vertical or horizontal abdominal incision. In these surgeries, the laparoscopic part of the procedure is finished before the uterine arteries are incised (ligation) through either the vaginal or abdominal incision. After removal of the uterus and other structures (ovaries, tubes), laparoscopic and abdominal incisions are closed with sutures or staples. Average recovery time from a combined procedure is approximately 4 to 6 weeks.

Increasingly, supracervical hysterectomy is being performed to remove the uterus and spare the cervix. In this procedure, the uterus may be broken into small pieces (morcellated) rather than incised. "Cutting current" may be used to cauterize the cut end of the cervix. Surgeons who prefer this procedure suggest that keeping the cervix is less apt to disturb nerves related to bladder and bowel function, thereby reducing complications. Sexual function is also thought to be preserved by retaining the cervix. Supracervical procedures can be performed abdominally or laparoscopically and are generally simpler procedures that take less time to perform. Recovery times parallel those of other types of hysterectomy. One possible disadvantage of the procedure is that risk of cervical cancer is not eliminated.

Source: Medical Disability Advisor



Prognosis

The prognosis following an uncomplicated hysterectomy is good, regardless of the type of procedure performed. Symptoms are usually relieved by the procedure, and a full return to normal activities can be expected.

When hysterectomy is performed for cancer of the cervix or uterus, the prognosis depends upon the extent and severity of the cancer. Early-stage or low-grade cancer has a generally good prognosis, whereas more advanced stages or high-grade cancer with extensive spreading (metastasis) has a poor prognosis.

A woman who has not undergone menopause may experience early menopause or symptoms associated with menopause after hysterectomy.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation depends on the type of surgery and if any complications occurred. Therapy can consist of walking, pelvic floor exercises, and / or core abdominal exercises. In most cases, formal physical therapy is not needed.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistHysterectomy
Physical Therapist Up to 3 visits within 6 weeks depending on type of surgery for home exercise program instruction.

Source: Medical Disability Advisor



Complications

Complications may vary according to the type of hysterectomy performed. Complications may include adverse reaction to anesthesia, infection at the surgical site, and excessive bleeding. Urinary problems are possible after the procedure, such as varying degrees of incontinence and urinary tract infections. Injury to the bladder, ureter, or bowels can occur, which would require surgical repair. Another complication is abnormal blood clotting in the legs or pelvic veins (thrombophlebitis). Depression, altered perceptions of one’s femininity, and sexual dysfunction may rarely occur after a hysterectomy.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Heavy lifting, prolonged standing, and strenuous physical activity will be restricted for as long as 6 to 12 weeks.

Risk: Heavy lifting and prolonged standing will be restricted for 6 weeks after surgery. Lifting must be kept to a minimum to avoid strain and allow internal healing after a hysterectomy.

Capacity: The amount of weight that can be lifted varies according to many factors such as type of hysterectomy procedure, preoperative strength, and the rate of overall recovery.

Tolerance: Within the capacity guides provided, pain is a limiting factor.

Accommodations: Appropriate accommodations can allow for safety and early return to work options which are in the individual’s best interests.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 to 90 days.

Source: Medical Disability Advisor



References

Cited

American College of Obstetricians and Gynecologists. "Choosing the Route of Hysterectomy for Benign Disease." Obstetrics and Gynecology 114 (2009): 1156-1158.

Parker, W. H. "Total Laparoscopic Hysterectomy and Laparoscopic Supracervical Hysterectomy." Obstetrics and Gynecology Clinics 31 3 (2004): 523-537.

Source: Medical Disability Advisor






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