Background. Evaluation of the criteria influencing certification regarding the ability to work on patients after operation on the arterial system of lower limbs.
Material and methods. Thirty-two patients took part in the study in production age (from 39 to 61 years, median 49) after lower limb arterial reconstruction (open or endovascular). In selected patients, atherosclerotic lower limb ischaemia was the only disease diagnosed and treated by physicians. 12–48 month postoperative follow-up was without complications. Claudication, measured on a treadmill test, varied from 120 to 1100 metres. Mean ankle-brachial index (ABI) was 0.7. After six months, patients were reassessed for reevaluation of the ABI and claudication with analysis of the certification decision made by welfare doctors. Statistical analyses of the data were performed using the Mann Whitney, χ² and t-Student tests for justification of the decision of welfare doctors.
Results. All patients, after open surgery, received positive welfare decisions. In 12 patients, complete inability to work was certified and in 10, partial inability to work. In patients who underwent endovascular surgery, partial inability to work was certified in five patients and negative welfare decision was found in another five patients. The difference in positive and negative welfare certification was statistically significant between open and endovascular surgery groups (p < 0.005). No difference in claudication distance and ABI value was observed between groups. The distance of claudication and ABI value had no influence on the welfare decision (p = 0.3). The type of open surgery and location of endovascular procedure were insignificant regarding certification of ability to work (p = 0.2). Certification of complete inability to work after surgery was not related to the ABI value or claudication distance for either type of open surgery (p = 0.02).
Conclusions. Certification after vascular reconstruction has thus far been based on the subjective impressions of welfare doctors and depends only on the presence of open surgery history with no relation to objective status of the patient or stage of the disease. The obtained results reveal the poor knowledge at present regarding atherosclerotic ischaemia of lower extremities diagnostic criteria - something which should be changed through obligatory scholarship of medical welfare doctors.