Salcedo-Wasicek M C, Thirlby R C
Department of Surgery, Virginia Mason Medical Center, Seattle.
Arch Surg. 1995 Jan;130(1):29-32. doi: 10.1001/archsurg.1995.01430010031006.
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.
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.
All inguinal herniorrhaphies were performed at a single clinic by one of seven surgeons.
Twenty-two consecutive patients receiving workers' compensation and 22 patients with commercial insurance were studied.
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.
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).
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).
为证实我们的观察结果，即与个体经营患者相比，患有与工作相关疝气的患者在疝气修复后恢复时间更长且疼痛持续时间更长，我们回顾了我们最近在一系列接受腹股沟疝修补术患者中的经验。
本研究设计为匹配回顾性病例对照研究。每例接受工伤赔偿的患者在年龄和性别上与同年接受商业保险的对照患者相匹配。
所有腹股沟疝修补术均由七位外科医生中的一位在单一诊所进行。
对22例连续接受工伤赔偿的患者和22例有商业保险的患者进行了研究。
将22例连续接受工伤赔偿患者的术后病程与22例有商业保险的对照患者的术后病程进行比较。比较的主要因素包括手术指征、疝气类型、进行的手术修复、术后疼痛持续时间以及每日工作缺勤天数。
两组的平均年龄均为46岁。工伤赔偿组的疝气症状更常见。工伤赔偿患者的术后疼痛持续时间（均值±标准误）为111.0±42.2天，有商业保险的患者为17.8±7.9天（P<0.05）。接受工伤赔偿患者的工作缺勤天数（均值±标准误）为33.5±4.6天，有商业保险的患者为12.6±2.3天（P<0.001）。
我们认为我们的结果证实了以下观察结果，即保险覆盖类型会影响腹股沟疝修补术后的恢复时间。其他测量疝气修补等手术程序后患者预后的研究应将保险覆盖类型作为可能影响早日重返工作岗位的一个因素。使用多变量分析，独立影响疝气修复后疼痛持续时间的唯一变量是保险覆盖类型（P<0.005）。
