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Short-term outcomes in open vs. laparoscopic herniorrhaphy: confounding impact of worker's compensation on
J S Barkun1, E J Keyser, M J Wexler
1Division of General Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
Insights
Laparoscopic inguinal herniorrhaphy (LH) showed faster recovery than open herniorrhaphy (OH) in patients without worker's compensation. Disability compensation significantly impacts convalescence duration in hernia repair trials.
Area of Science:
- Surgery
- Gastroenterology
- Clinical Trials
Background:
- Inguinal hernias are common surgical conditions.
- Open herniorrhaphy (OH) and laparoscopic inguinal herniorrhaphy (LH) are common repair methods.
- Convalescence duration is a key patient outcome measure.
Purpose of the Study:
- To compare the duration of convalescence between open herniorrhaphy (OH) and laparoscopic inguinal herniorrhaphy (LH).
- To identify potential confounding variables affecting recovery times in hernia repair surgery.
Main Methods:
- A randomized controlled trial involving 123 patients with unilateral inguinal hernia.
- Patients were assigned to either open herniorrhaphy (OH) or laparoscopic inguinal herniorrhaphy (LH).
- Primary endpoint: duration of convalescence. Secondary analysis excluded patients receiving worker's compensation.
Main Results:
- No significant difference in convalescence duration between OH and LH groups overall (11.6 vs. 9.8 days).
- LH patients without worker's compensation recovered 3 days faster than OH patients (10.9 vs. 7.8 days; P=0.02).
- Worker's compensation status was a significant confounding variable in recovery time.
Conclusions:
- Laparoscopic inguinal herniorrhaphy (LH) may offer faster recovery than open herniorrhaphy (OH) for patients not receiving worker's compensation.
- Future trials must control for disability compensation to accurately assess hernia repair outcomes.
- Convalescence duration is influenced by factors beyond surgical technique.
Abstract:
Over a 28-month period, 123 patients with a unilateral inguinal hernia were recruited into a randomized controlled trial comparing open herniorrhaphy (OH) to laparoscopic inguinal herniorrhaphy (LH). The primary end point was duration of convalescence. Sixty-five patients underwent OH and 58 underwent LH. Both groups were well matched for all baseline parameters, although LH patients anticipated a shorter convalescence than OH patients (14.3 +/- 9.4 days vs. 18.5 +/- 10.8 days; P = 0.021). The median duration of hospital stay was one day in both groups. No difference was observed in the duration of convalescence (LH 9.8 +/- 7.4 days; OH 11.6 +/- 7. 7 days) across groups. However, when the data were analyzed after removing patients receiving disability ("worker's") compensation (21 patients), patients undergoing LH recovered on average 3 days faster (LH 7.8 +/- 5.6 days; OH 10.9 +/- 7.5 days; P = 0.02). Patients not receiving worker's compensation appear to have a shorter convalescence after LH compared to OH. Disability compensation is a major confounding variable in determining convalescence and needs to be controlled for in any future trial design.
