Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving workers' compensation vs patients with commercial insurance
M. C. Salcedo-Wasicek and R. C. Thirlby
Department 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).
