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Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving workers'
M C Salcedo-Wasicek1, R C Thirlby
1Department of Surgery, Virginia Mason Medical Center, Seattle.
Objective:
To confirm our observation that patients with work-related hernias, when compared with self-employed patients, had longer recovery times and prolonged pain after hernia repairs, we reviewed our recent experience in a series of patients undergoing inguinal hernia repairs.
Design:
The study design was matched retrospective case-control. Each patient receiving workers' compensation was age and sex matched with a control patient with commercial insurance whose repair was done during the same year.
Setting:
All inguinal herniorrhaphies were performed at a single clinic by one of seven surgeons.
Patients:
Twenty-two consecutive patients receiving workers' compensation and 22 patients with commercial insurance were studied.
Main Outcome Measures:
The postoperative courses in 22 consecutive patients with workers' compensation were compared with those in 22 control patients with commercial insurance. The principal factors compared were indications for surgery, type of hernia, surgical repair performed, the duration of postoperative pain, and the number of days off daily work.
Results:
The average age in both groups was 46 years. Hernias in the workers' compensation group were more frequently symptomatic. The duration of postoperative pain (mean +/- SE) was 111.0 +/- 42.2 days for patients with workers' compensation and 17.8 +/- 7.9 days for patients with commercial insurance (P < .05). The number of days off work (mean +/- SE) was 33.5 +/- 4.6 days for patients receiving workers' compensation and 12.6 +/- 2.3 days for patients with commercial insurance (P < .001).
Conclusions:
We believe our results confirm the observation that type of insurance coverage influences post-operative recovery time after inguinal herniorrhaphy. Other studies measuring a patient's outcome after surgical procedures such as herniorrhaphy should include type of insurance coverage as a factor that might affect early return to work. Using multivariate analysis, the only variable independently affecting the duration of pain after hernia repair was the type of insurance coverage (P < .005).