Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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J.S. Pachman and B.P. Jacob
Evidence and Recommendations
There is significant variability in recommendations regarding return
to work post-herniorrhaphy [ 2 ]. Survey data suggest that when the
occupational job demands involve heavy lifting, return to work recommendations
vary from a few days to as long as 3 months post-op [ 3 ].
There is evidence that post- herniorrhaphy recommendations for early
return to work and unrestricted activity are more likely to result in functional
recovery [ 4 ]. There is good evidence that return to full duty work,
even with high physical demands, should generally not exceed 30 days and
this time should generally be even less with laparoscopic surgery [ 2 ]. Even
in the case of more conservative recommendations for return to work with
physical demands that include frequent lifting of greater than 25 lbs., disability
of more than 6–8 weeks is not supported by available evidence [ 5 ].
Return to Work
In most cases, return to work recommendations can include timelimited
initial work restrictions (e.g., sedentary work). These recommendations
should never be based on the patient report of job availability,
but instead upon sound medical judgment regarding work capacity.
Even if accommodated work is not available, this determination is occupational,
not medical. Furthermore, there is a good deal of evidence that
early return to work, even with appropriate time-limited restrictions,
reduces long-term disability [ 6 ].
In general, workers’ compensation carriers are motivated by expeditious
return to work, quality outcomes, appropriately limited use of preand
postoperative opiate analgesics, and the absence of recurrence.
Regarding the latter, the available evidence suggests that there is no
difference related to recurrence in the case of early return to work following
elective inguinal repair [ 6 ]. Not surprisingly, self-employed postherniorrhaphy
patients have been found to return to work sooner than
those patients who are receiving disability benefits [ 7 ]. There is also
evidence that workers’ compensation patients report a greater duration
of pain and disability post- herniorrhaphy as compared to patients who
are receiving group health benefits [ 8 ].