Article

Returning to work after herniorrhaphy.

BMJ Clinical Research (Impact Factor: 14.09). 11/1994; 309(6958):880. DOI: 10.1136/bmj.309.6958.880b
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Available from: Dean E Boyce, Feb 28, 2014
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    ABSTRACT: The rapid and widespread introduction of minimal access surgery has major implications for the National Health Service. It cannot be assumed that replacing an open procedure with a minimal access alternative will be cost-effective. Laparoscopic inguinal hernia repair is a procedure for which the potential economic benefits are particularly unclear. It is currently being adopted in many centres, although limited evidence on its clinical and cost-effectiveness exists. This economic comparison of laparoscopic versus open hernia repair was undertaken on data collected on 104 patients undergoing surgery on a day case basis, in the context of a randomized controlled trial. The mean total health service cost of laparoscopic repair was 1074 pounds versus 489 pounds for open repair [mean difference in total health service costs 583 pounds; 95 percent confidence interval (CI) 265 pounds-904 pounds]. This difference was largely accounted for by the difference in theatre costs. Laparoscopic repair remained significantly more expensive for most but not all of the scenarios explored in the sensitivity analysis. The direction of the cost-effectiveness ratio was not sensitive to assumptions about long-term recurrence. Neither was it sensitive to halving the operating time in the laparoscopic arm of the trial. When both operating time and the costs of consumables were reduced, laparoscopic repair remained more expensive, but results for this scenario did not achieve statistical significance on this sample size. Laparoscopic hernia repair appears an expensive option in most plausible situations. Furthermore, many uncertainties still exist about long-term outcome after the procedure and about the conditions necessary to maximize cost-effectiveness. Large-scale randomized studies to evaluate laparoscopic hernia repair are currently under way to address these issues. We suggest that further evidence is awaited before this technology is further diffused.
    Journal of Public Health Medicine 04/1996; 18(1):41-8. DOI:10.1093/oxfordjournals.pubmed.a024460
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    ABSTRACT: Time back to work or normal activity is often regarded as an outcome measure of interest after surgery. It has recently been used as a way of quantifying the benefits of minimal access surgery. However, the extent to which variation in time back to normal reflects differences in health status is unclear. The relationship was examined in 140 patients recovering from inguinal hernia repair. A multi-dimensional measure of health status, the Short Form 36 (SF-36), was administered preoperatively, and at ten days and six weeks postoperatively. The relationship between scores on the SF-36 dimensions and return to normal activity was examined using correlation statistics and stepwise regression. Health status dimensions measuring role limitation owing to physical restriction at 10 days and 6 weeks, and role limitation owing to mental problems at ten days were associated with time to return to normal on univariate analysis. Social class was also strongly associated. Using stepwise regression these two dimensions of health status together explained 33 per cent of the variance in time to normal. Other factors unrelated to health status clearly contributed to this outcome. Time back to normal activity postoperatively is influenced by a number of factors unrelated to health status and is an unreliable proxy for it. Time to normal is therefore, not a good outcome measure for quantifying the benefits of surgical interventions. Claims currently being made to justify investment in some minimal access interventions should be interpreted in the light of this.
    Journal of Public Health Medicine 04/1996; 18(1):49-53. DOI:10.1093/oxfordjournals.pubmed.a024461
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