Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE
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REVIEW
Work‑relatedness of inguinal hernia: a systematic review including meta‑analysis and GRADE P. P. F. M. Kuijer1 · D. Hondebrink1 · C. T. J. Hulshof1 · H. F. Van der Molen1 Received: 10 April 2020 / Accepted: 25 May 2020 © The Author(s) 2020
Abstract Purpose Clinicians need to know whether inguinal hernia (IH) can be attributed to work to answer questions regarding prevention and medical causation. This review describes whether work-related risk factors are associated with IH. Methods A systematic review was performed in Medline via PubMed until February 3rd, 2020. Inclusion criteria were that IH was diagnosed by a clinician, and workers exposed to work-related risk factors were compared to workers less exposed or not at all. A quality assessment and a meta-analysis using Cochrane’s RevMan 5.3 were performed, including GRADE for quality of evidence. Results The search resulted in 540 references. Fourteen studies fulfilled the inclusion criteria, of which three were included in a meta-analysis, all three being of high quality, including 621 workers diagnosed with IH. The meta-analysis revealed significant associations with physically demanding work (OR 2.30, 95% CI 1.56–3.40). Two prospective studies, including 382 and 22,926 cases revealed associations that this was true for male workers with a lateral IH that reported standing or walking for more than six hours per workday (OR 1.45, 95% CI 1.12–1.88) or lifting cumulative loads of more than 4000 kg per workday (OR 1.32, 95% CI 1.27–1.38). The level of certainty for the latter two work-related risk factors was moderate and high according to GRADE. Conclusion Lateral IH among males is associated with work-related risk factors depending on the level of exposure to the time standing/walking per workday, or the amount of load lifted per workday. Keywords Occupational disease · Risk factors · Occupational exposure · Etiology · Prevention
Introduction Worldwide, more than 20 million patients undergo groin hernia repair annually, a vast majority being male workers of working age [1]. The international guidelines for groin hernia management established that risk factors for primary inguinal hernia (IH) among adults include: family history, previous contra-lateral hernia, male sex, age, abnormal Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10029-020-02236-0) contains supplementary material, which is available to authorized users. * P. P. F. M. Kuijer [email protected] 1
Netherlands Center for Occupational Diseases, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
collagen metabolism, prostatectomy, and low body mass index [1]. Regarding work, the conclusion was that contradictory evidence existed that social class, occupational factors, and workload affect the risk of IH repair [1–3], and that heavy lifting may predispose to IH formation [1, 4].
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