POSTOPERATIVE COURSE AFTER INGUINAL HERNIORRHAPHY - A CASE-CONTROLLEDCOMPARISON OF PATIENTS RECEIVING WORKERS COMPENSATION VS PATIENTS WITH COMMERCIAL INSURANCE

Objective: To confirm our observation that patients with work-related hernias, when compared with self-employed patients, had longer recover y times and prolonged pain after hernia repairs, we reviewed our recen t experience in a series of patients undergoing inguinal hernia repair s. Design: The study design was matched retrospective case-control. Ea ch patient receiving workers' compensation was age and sex matched wit h a control patient with commercial insurance whose repair was done du ring the same year. Setting: All inguinal herniorrhaphies were perform ed at a single clinic by one of seven surgeons. Patients: Twenty-two c onsecutive patients receiving workers' compensation and 22 patients wi th commercial insurance were studied. Main Outcome Measures: The posto perative courses in 22 consecutive patients with workers' compensation were compared with those in 22 control patients with commercial insur ance. The principal factors compared were indications for surgery, typ e 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 grou p were more frequently symptomatic. The duration of postoperative pain (mean+/-SE) was 111.0+/-42.2 days for patients with workers' compensa tion 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 pat ients receiving workers' compensation and 12.6+/-2.3 days for patients with commercial insurance (P<.001). Conclusions: We believe our resul ts confirm the observation that type of insurance coverage influences postoperative recovery time after inguinal herniorrhaphy. Other studie s measuring a patient's outcome after surgical procedures such as hern iorrhaphy should include type of insurance coverage as a factor that m ight affect early return to work. Using multivariate analysis, the onl y variable independently affecting the duration of pain after hernia r epair was the type of insurance coverage (P<.005).