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.

Oophorectomy


Related Terms

  • Excision of Ovary
  • Ovariectomy

Specialists

  • General Surgeon
  • Obstetrician/Gynecologist

Comorbid Conditions

  • Abdominal adhesions
  • Allergies to pain medications
  • Heart disease
  • Lung disease
  • Obesity
  • Previous abdominal surgeries

Factors Influencing Duration

The length of disability may be influenced by the underlying condition, the age of the individual, the type of procedure performed, any surgical complications, and the individual's response to treatment.

Medical Codes

ICD-9-CM:
65.31 - Laparoscopic Unilateral Oophorectomy
65.39 - Unilateral Oophorectomy, Other
65.51 - Other Removal of Both Ovaries at Same Operative Episode; Female Castration
65.52 - Other Removal of Remaining Ovary; Removal of Solitary Ovary
65.53 - Laparoscopic Removal of Both Ovaries at Same Operative Episode
65.54 - Laparoscopic Removal of Remaining Ovary

Overview

Oophorectomy, sometimes referred to as ovariectomy, is the surgical removal of one ovary (unilateral oophorectomy) or both ovaries (bilateral oophorectomy).

When a unilateral oophorectomy is performed on premenopausal women, normal hormone production continues in the remaining ovary; individuals will continue to menstruate and be able to have children. However, when a bilateral oophorectomy is performed on premenopausal women, normal hormone production is halted, causing abrupt menopause and sterility. Because the estrogen levels of premenopausal women are higher than those of postmenopausal women, premenopausal women may require a much higher dose of hormone replacement than women who go on to enter menopause naturally.

Source: Medical Disability Advisor



Reason for Procedure

Oophorectomies are done to treat uterine or ovarian cancer, breast cancer, endometriosis, or benign ovarian tumors (fibromas or teratomas). The procedure may be necessary when an ovarian cyst does not respond to medical treatment or surgical removal (resection); when the ovarian blood supply is compromised (ovarian torsion); or when the ovaries have severe involvement by tumors, infection from pelvic inflammatory disease, scar tissue (adhesions), or abnormal tissue growth (endometriosis).

A unilateral oophorectomy may be performed to remove an abscess, benign tumor, or large ovarian cyst or to treat severe endometriosis. One or both ovaries may be removed during the surgical removal of the uterus (hysterectomy), particularly if there is an underlying disease that has spread from the uterus to the ovaries. A bilateral oophorectomy is frequently performed to treat ovarian or uterine cancer. It may also be performed on women with breast cancer to reduce the amount of hormones (estrogens) produced by the ovaries that may stimulate growth of the cancer.

Healthy ovaries may be removed as a preventive measure to reduce the risk of ovarian cancer or breast cancer in high-risk women (prophylactic oophorectomy).

Source: Medical Disability Advisor



How Procedure is Performed

Unilateral or bilateral oophorectomy may be performed by traditional open abdominal surgery (laparotomy), laparoscopy, minilaparotomy, or colpotomy. The procedure is performed in a hospital or outpatient clinic under regional (spinal or epidural) or general anesthesia.

Laparotomy is indicated when the ovaries need to be removed intact, as in the case of cancer. It is also indicated for individuals who have internal scar tissue (adhesions) because of the increased risk of cutting the intestines when detaching the ovaries. For laparotomy, a vertical or horizontal incision is made to open the abdomen and expose the ovaries.

Laparoscopy, indicated for noncancerous conditions, is the most commonly used method to perform an oophorectomy. During laparoscopy, the abdominal cavity is inflated with carbon dioxide gas (pneumoperitoneum) to allow visualization within the abdomen, provide an open work space, and reduce the incidence of complications. The gas is injected into the abdominal cavity through a needle (Veress needle). One or more small incisions are made into the abdominal cavity, and tubes (trocars) are inserted. Once the surgeon inserts a slender, lighted, telescope-like viewing instrument (laparoscope) through a trocar, the abdominal cavity can be viewed on a video screen. Small instruments, which are either passed alongside the laparoscope or inserted through other trocars, are used to perform the surgery. Once the ovaries are detached, they may be cut into small pieces and removed through the trocars, or removed whole through a small incision at the top of the vagina (colpotomy).

Another common method, the minilaparotomy, involves making a 2-inch-long incision in the lower abdomen; it relies upon direct visualization and removal through the single incision.

The ovaries may also be removed through colpotomy. It allows the ovaries to be removed intact and is less traumatic than laparotomy, but this approach is rarely used today due to increased risk of infection and limited exposure.

There are 3 different methods for cutting the attachments that secure the ovary in the pelvis: the ligature method (which uses loops of catgut or synthetic suture material to tie off supportive ligaments), an automatic stapling method (which staples off the supportive ligaments), and the bipolar coagulation method (which destroys or cauterizes the supportive tissue). The ovary is freed after all supportive structures have been cut. With laparoscopy, the ovary is cut into pieces that are small enough to be removed through the trocar. If malignancy is suspected, the ovary is removed whole, often inside collapsible laparoscopic bags to avoid the risk of material spillage. Any incisions made during the procedure are closed with stitches (sutures). Antibiotics and analgesics are generally prescribed prophylactically.

Decisions regarding the most appropriate method depend mainly on the indications for the surgery, the size and condition of the ovaries, the woman's weight, the number of prior lower abdominal surgeries, and any history of heart and lung disease. Generally, laparoscopy, minilaparotomy, and colpotomy are performed on an outpatient basis, while the individual is hospitalized for a laparotomy.

Source: Medical Disability Advisor



Prognosis

The predicted outcome after oophorectomy depends on the reason for the procedure (i.e., removal of cyst, tumor, abscess, or ectopic pregnancy; or treatment of ovarian or breast cancer, endometriosis, or pelvic inflammatory disease); whether the method was a laparotomy, laparoscopy, mini-laparotomy, or colpotomy; and whether the procedure was unilateral or bilateral. Individuals who have a laparoscopy recover more quickly and with fewer problems than those who have laparotomy; recovery time from a laparotomy is typically within 4 to 6 weeks ("Oophorectomy"). After bilateral pre-menopausal oophorectomy, the woman will be at increased risk for osteoporosis, coronary heart disease, lung cancer, and cognitive impairment (dementia) unless hormone replacement therapy is implemented, and will become infertile (Liu, Rocca).

Source: Medical Disability Advisor



Complications

If oophorectomy is performed under general anesthesia, the individual may have a reaction to the anesthesia or have difficulty breathing.

The Veress needle or trocar may injure major abdominal or pelvic vessels, or damage the intestines, bladder, or tubes leading from the kidneys to the bladder (ureters). The ureters may be cut when the ovaries are being excised. Rarely, the intestine may protrude out of the incisions (herniate). Bleeding (hemorrhage), infection, and blood clots (thromboembolism) are complications of any surgical procedure. Abdominal surgery may lead to formation of internal scar tissue (adhesions), which may cause pain, intestinal stricture, or infertility. Failure to remove the entire ovary can result in ovarian remnant syndrome.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Most individuals who are treated with laparoscopies are able to return to work or to resume previous activities with only minor restrictions; they may need to refrain from strenuous exercise or heavy lifting for up to 4 weeks. Individuals treated with more invasive procedures (mini-laparotomy or laparotomy) usually require a longer leave of absence from work and more stringent restrictions for up to 6 weeks (“Oophorectomy”). Women who underwent laparotomy may be temporarily unable to drive a car or other motor vehicles. An abdominal incision creates trunk weakness; because of poor trunk stabilization, the lower extremity reaction time is slowed and the risk of an accident may be higher if individuals who have this surgery cannot brake in time.

Allowances may also need to be made for rest periods, shorter work hours, and/or fewer work days per week. Additional sick leave may be necessary if post-surgery treatment includes chemotherapy and radiation for cancer treatment. Use of prescribed medications for management of pain and inflammation may require review of drug policies. Safety issues may need to be evaluated.

Source: Medical Disability Advisor



References

Cited

"Oophorectomy." Encyclopedia of Surgery. Advameg, Inc. 30 Jul. 2009 <http://www.surgeryencyclopedia.com/La-Pa/Oophorectomy.html>.

"Oophorectomy: Topic Overview." WebMD.com. 12 Aug. 2008. WebMD, LLC. 30 Jul. 2009 <http://www.webmd.com/ovarian-cancer/tc/oophorectomy-topic-overview>.

Entman, Stephen S., et al. "Gynecologic Surgery." Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Eds. Courtney M. Townsend, et al. 18th ed. Philadelphia: Saunders Elsevier, 2007.

Liu, Y., et al. "Reproductive Factors, Hormone Use and the Risk of Lung Cancer Among Middle-aged Never-Smoking Japanese Women: A Large-Scale Population-Based Cohort Study." International Journal of Cancer 117 4 (2005): 662-666.

Rocca, W. A., et al. "Increased Risk of Cognitive Impairment or Dementia in Women Who Underwent Oophorectomy Before Menopause." Neurology 69 11 (2007): 1074-1083.

Source: Medical Disability Advisor






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