Short-term outcomes in open vs. laparoscopic herniorrhaphy: confounding impact of worker's compensation on convalescence.
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.
Barkun
J S
JS
Division of General Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
Keyser
E J
EJ
Wexler
M J
MJ
Fried
G M
GM
Hinchey
E J
EJ
Fernandez
M
M
Meakins
J L
JL
D015986:Confounding Factors, Epidemiologic; D003289:Convalescence; D006552:Hernia, Inguinal / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D011792:Quebec; D013997:Time Factors; D014942:Workers' Compensation / Q000706:statistics & numerical data*