Vad M V, Frost P, Svendsen S W
Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark.
Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
Hernia. 2015 Dec;19(6):893-900. doi: 10.1007/s10029-014-1339-0. Epub 2014 Dec 24.
The aim of this study was to evaluate exposure-response relationships between occupational mechanical exposures and risk of reoperation after inguinal hernia repair.
Using register information, we identified all men born in Denmark 1938-1988, who had their first inguinal hernia repair 1998-2008, and who were 18-65 years old and active in the labour market at the time of surgery. The Danish Hernia Database provided information on repairs and reoperations. We used registered occupational codes and a job exposure matrix based on experts' ratings to estimate total load lifted per day, frequency of heavy lifting, and number of hours per day spent standing/walking. We also obtained register information on sickness absence. Multivariable Cox regression analysis was used.
The cohort comprised 34,822 patients. We did not reveal exposure-response relationships between occupational mechanical exposures and the hazard ratio (HR) of reoperation. The percentage of patients with >2 weeks of sickness absence within 8 weeks after surgery increased with total load lifted per day from 15 to 53%. Longer sickness absence was associated with an increased HR of reoperation, but within strata of sickness absence, we found no increase in the HR of reoperation with increasing exposures.
We did not find indications that the HR of reoperation was related to occupational mechanical exposures, even after accounting for a potential protective effect of sickness absence. Hence, the exposure-related prolonged duration of sickness absence could not be explained by exposure-related complications that led to reoperation.
本研究旨在评估职业机械暴露与腹股沟疝修补术后再次手术风险之间的暴露-反应关系。
利用登记信息，我们确定了所有1938年至1988年出生在丹麦、1998年至2008年接受首次腹股沟疝修补术、手术时年龄在18至65岁且活跃于劳动力市场的男性。丹麦疝数据库提供了有关修补和再次手术的信息。我们使用登记的职业代码和基于专家评级的工作暴露矩阵来估计每天举起的总负荷、重物举起的频率以及每天站立/行走的小时数。我们还获得了病假登记信息。采用多变量Cox回归分析。
该队列包括34822名患者。我们未发现职业机械暴露与再次手术的风险比（HR）之间存在暴露-反应关系。术后8周内病假超过2周的患者百分比随着每天举起的总负荷从15%增加到53%。病假时间越长，再次手术的HR越高，但在病假分层内，我们发现随着暴露增加，再次手术的HR没有增加。
我们没有发现迹象表明再次手术的HR与职业机械暴露有关，即使在考虑了病假的潜在保护作用之后。因此，与暴露相关的病假延长持续时间不能用导致再次手术的暴露相关并发症来解释。
