The Relationship of Work Requiring Heavy Lifting to the Severity of Inguinal Hernia at Prof. Dr. Margono Soekarjo Purwokerto General Hospital for the 2022–2023 Period

Gregorius Christian Hamid; Yonathan Adi  Purnomo

doi:10.71435/738851

Authors

Gregorius Christian Hamid Universitas Tarumanagara
Yonathan Adi Purnomo Universitas Tarumanagara

DOI:

https://doi.org/10.71435/738851

Keywords:

Inguinal Hernia, Hernia Severity, Heavy Lifting, Blue-Collar Workers, Occupational Health

Abstract

This study examined the association between occupations involving heavy lifting and the severity of inguinal hernia among patients treated at Prof. Dr. Margono Soekarjo Hospital, Purwokerto, during the 2022-2023 period. A retrospective observational analytical study with a cross-sectional approach was conducted using secondary data from hospital medical records. The study included 190 adult patients diagnosed with inguinal hernia who met the inclusion and exclusion criteria. Occupational category was classified into blue-collar and white-collar work, with blue-collar work used as a proxy for regular manual labor and heavy lifting. Hernia severity was categorized into uncomplicated and complicated hernia based on documented clinical diagnosis. Data were analyzed using univariate analysis, Chi-square test, and Odds Ratio estimation with a 95% confidence level. Most patients were male (91.6%) and aged 46-65 years (52.6%). Blue-collar workers accounted for 56.8% of the sample, while white-collar workers accounted for 43.2%. Most patients had uncomplicated hernia (90.0%), while 10.0% had complicated hernia. The bivariate analysis showed a significant association between occupational category and inguinal hernia severity (p = 0.040). Blue-collar workers had approximately 3.1 times higher odds of experiencing complicated inguinal hernia than white-collar workers (OR = 3.145). These findings suggest that physically demanding occupations may be associated with greater clinical severity of inguinal hernia and should receive attention in occupational health screening and surgical referral decisions. However, the retrospective cross-sectional design limits causal inference, and residual confounding remains possible due to incomplete documentation of obesity, smoking, chronic cough, constipation, and comorbidities. Future prospective studies are therefore needed.

References

Abebe, M. S., Tareke, A., Alem, A., Debebe, W., & Beyene, A. (2022). Worldwide magnitude of inguinal hernia: A systematic review and meta-analysis of population-based studies. SAGE Open Medicine, 10, 20503121221139150. https://doi.org/10.1177/20503121221139150

Adamopoulos, I. P., & Syrou, N. F. (2022). Workplace safety and occupational health job risks hazards in public health sector in Greece. European Journal of Environment and Public Health, 6(2), em0118. https://doi.org/10.21601/ejeph/12229

Afolabi, O. G., Adegbamigbe, A. B., Oluwajuyigbe, M. E., Okunlola, A. I., Adegbamigbe, A., & Oluwajuyigbe, M. (2026). Patterns and Outcomes of Surgically Treated Non-traumatic Acute Abdomen in a Teaching Hospital in Nigeria: A 10-Year Retrospective Study. Cureus, 18(6). https://doi.org/10.7759/cureus.110608

Almarhabi, T. A., Almahdawi, M. S., Ibrahim, H., & Alnashri, K. H. (2022). Knowledge and attitude towards hernia among adults in Al-Qunfudhah, Saudi Arabia; a cross-sectional community-based study. hernia, 9, 10.

Andriani, M., Hasan, M. T., & Fradila, S. (2017). Perbaikan beban kerja pegawai tidak tetap badan pertanahan nasional melalui redesign system. Jurnal Sistem Teknik Industri, 19(2), 95–102.

Biernat, E., & Piątkowska, M. (2023). Sedentary behaviour as a lifestyle risk factor in public health–Evidence of white-collar and blue-collar workers from Poland. Annals of Agricultural and Environmental Medicine, 30(4), 743-748. https://doi.org/10.26444/aaem/165980

Colla, N., Maul, J. T., Vallejo-Yagüe, E., Burden, A. M., Möller, B., Nissen, M. J., ... & Micheroli, R. (2024). Impact of blue-collar vs. white-collar occupations on disease burden in psoriatic arthritis patients: A Swiss clinical quality management in rheumatic diseases cohort study. Clinical Rheumatology, 43(10), 3147-3155. https://doi.org/10.1007/s10067-024-07077-1

Council for Medical Schemes. (2023). Final prescribed minimum benefit (PMB) definition guideline: Uncomplicated hernias below 18 years and hernias with obstruction or gangrene. CMS.

Croghan, S. M., Mohan, H. M., Breen, K. J., McGovern, R., Bennett, K. E., Boland, M. R., ... & Fleming, C. A. (2023). Global incidence and risk factors associated with postoperative urinary retention following elective inguinal hernia repair: the retention of urine after inguinal hernia elective repair (RETAINER I) study. JAMA surgery, 158(8), 865-873. https://doi.org/10.1001/jamasurg.2023.2137

de Freitas Cardoso, V., Stefane, C. A., de Barros, F. C., Gonçalves, J. S., Figueiredo, L. C., & de Oliveira Sato, T. (2022). Influence of gender and age on musculoskeletal symptoms in white-collar and blue-collar workers: a cross-sectional study. International Journal of Occupational Safety and Ergonomics, 28(4), 2482-2491. https://doi.org/10.1080/10803548.2022.2037325

Dixon, R., & Lacy, M. (2018). Risk factors for inguinal hernia: A review of the literature. American Journal of Surgery, 215(4), 658–663. https://doi.org/10.1016/j.amjsurg.2017.12.012

Dudai, M., & Paajanen, H. (2025). Narrative Review and Clinical Recommendations for Sportsman’s Hernia and Athletic Pubalgia Based on 30 Years of Expert Experience. Journal of Abdominal Wall Surgery, 4, 15394.

Dwyer, D., Ye, R. R., Nelson, B., & McGorry, P. (2025). Clinical staging for psychiatry and psychology. Annual Review of Clinical Psychology, 21(1), 497-527. https://doi.org/10.1146/annurev-clinpsy-081423-025310

Farooq, S., Chaudhry, A., Ahmad, Z., Khan, M. A., & Rehman, A. U. (2019). Ultrasound diagnosis of hernia. Journal of Clinical Imaging Science, 9(1), 58. https://doi.org/10.25259/JCIS_78_2019

Ferranti, F. (2023). Incarcerated Inguinal Hernia in the Elderly: Surgical Implication. In Hernia Updates and Approaches. IntechOpen.

Fitzgibbons Jr, R. J., & Forse, R. A. (2015). Groin hernias in adults. New England Journal of Medicine, 372(8), 756-763.

Grabara, M. (2025). Prevalence of musculoskeletal disorders among Polish white-collar workers: the role of physical activity and risk factors. Frontiers in Public Health, 13, 1551728. https://doi.org/10.3389/fpubh.2025.1551728

Güneş, E., & Ayaz‐Alkaya, S. (2022). The effect of health education on prevention of low back pain for health caregivers and cleaning workers. International Journal of Nursing Practice, 28(1), e12973. https://doi.org/10.29011/2574-7754.101054

Hasibuan, M. S. P. (2001). Manajemen sumber daya manusia. Bumi Aksara.

Hollingshead, J., & Thomas, C. T. (2025). Emergency small and large bowel surgery and surgery for benign disease. In Farquharson's Textbook of Operative General Surgery (pp. 243-271). CRC Press. https://doi.org/10.1201/9781003341710

Huang, Y., Lee, J., McFadden, A. C., Murphy, L. A., Robertson, M. M., Cheung, J. H., & Zohar, D. (2017). Ergonomics and musculoskeletal disorders in the workplace. International Journal of Environmental Research and Public Health, 14(12), 1560. https://doi.org/10.3390/ijerph14121560

Huerta, S., & Garza, A. M. (2025). A systematic review of open, laparoscopic, and robotic inguinal hernia repair: management of inguinal hernias in the 21st century. Journal of Clinical Medicine, 14(3), 990. https://doi.org/10.3390/jcm14030990

Hutsebaut, J., Videler, A. C., Verheul, R., & Van Alphen, S. P. (2019). Managing borderline personality disorder from a life course perspective: Clinical staging and health management. Personality Disorders: Theory, Research, and Treatment, 10(4), 309. https://doi.org/10.1037/per0000341

Joyce, S., Murphy, K. P., Maher, M. M., & O'Connor, O. J. (2022). Abdominal cavity: anatomy, structural anomalies, and hernias. Yamada's Textbook of Gastroenterology, 131-145.

Kuijer, P. P. F. M., Hondebrink, D., Hulshof, C. T. J., & van der Molen, H. F. (2020). Work-relatedness of inguinal hernia: A systematic review including meta-analysis and GRADE. Hernia, 24(5), 943–950. https://doi.org/10.1007/s10029-020-02193-1

Ma, Q., Jing, W., Liu, X., Liu, J., Liu, M., & Chen, J. (2023). The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019. International Journal of Surgery, 109, 333–342. https://doi.org/10.1097/JS9.0000000000000025

Nixon, A. E., Mazzola, J. J., Bauer, J. R., Krueger, J. R., & Spector, P. E. (2011). Can work stress interfere with health and work performance? Journal of Applied Psychology, 96(2), 361–376. https://doi.org/10.1037/a0021726

Oakman, J., Macdonald, W. A., & McCredie, K. (2023). Psychosocial hazards play a key role in differentiating MSD risk levels of workers in high-risk occupations. Applied Ergonomics, 112, 104053. https://doi.org/10.1016/j.apergo.2023.104053

Octaviaji, M. R., & Hidayati, R. A. (2021). Analisis beban kerja mental karyawan di laboratorium PT ABC menggunakan metode NASA-TLX. Jurnal Ergonomi Indonesia, 7(1), 23–30.

Odebiyi, D. O., & Okafor, U. A. C. (2023). Musculoskeletal disorders, workplace ergonomics and injury prevention. In Ergonomics-new insights. IntechOpen. https://doi.org/10.5772/intechopen.106031

Pirvu, C., Pantea, S., Popescu, A., Grigoras, M. L., Bratosin, F., Valceanu, A., ... & Selaru, M. (2022). Difficulties in diagnosing extraperitoneal ureteroinguinal hernias: a review of the literature and clinical experience of a rare encounter in acute surgical care settings. Diagnostics, 12(2), 353. https://doi.org/10.3390/diagnostics12020353

Quick, J. A., Beffa, L. R., & Barnes, S. L. (2022). Abdominal Wall Hernias. In The Acute Management of Surgical Disease (pp. 177-195). Cham: Springer International Publishing.

Rembune, Z., Syapitri, S., Lubis, Z. A., & Saragi, M. P. D. (2022). Aspirasi karir mahasiswa tingkat akhir BPI UIN Sumatera Utara dalam mencari pekerjaan. Jurnal Pendidikan dan Konseling (JPDK), 4(6), 2950–2956. https://doi.org/10.31004/jpdk.v4i6.8667

Rios-Diaz, A. J., Cunning, J., Hsu, J. Y., Elfanagely, O., Marks, J. A., Grenda, T. R., ... & Fischer, J. P. (2021). Incidence, burden on the health care system, and factors associated with incisional hernia after trauma laparotomy. JAMA surgery, 156(9), e213104. https://doi.org/10.1001/jamasurg.2021.3104

Rochet, S., & McDonald, A. (2015). Biomechanics of heavy lifting and hernia development. Journal of Surgical Research, 193(2), 424–429. https://doi.org/10.1016/j.jss.2014.08.056

Rozell, E., Pettijohn, C., & Parker, R. (2011). White vs. blue: Does the collar color affect job attitudes and behaviors? Academy of Strategic Management Journal, 10, 65–80.

Ruhl, C. E., & Everhart, J. E. (2007). Risk factors for inguinal hernia among adults in the US population. American journal of epidemiology, 165(10), 1154-1161. https://doi.org/10.1093/aje/kwm011

Sayuti, M., & Aprilita, R. (2023). Teknik operasi hernia inguinalis dan faktor risiko hernia inguinalis residif di 7 rumah sakit perifer di Aceh. Jurnal Ilmu Kesehatan dan Gizi, 1(3), 98–107. https://doi.org/10.55606/jikg.v1i3.1612

Shams, M., Kapur, A., Mian, A., & Marples, R. (2025). Abdominal Wall, Bowel Obstruction and Hernia. In Hamilton Bailey's Emergency Surgery (pp. 582-599). CRC Press. https://doi.org/10.1016/j.emc.2011.01.004

Sharma, D., Singh, A., & Bhardwaj, S. (2023). Inguinal hernias in adults: Epidemiological, clinical and surgical aspects. International Journal of Surgery Research, 10(3), 12–19.

Soto-Rodríguez, F. J., Pérez-Mármol, J. M., Bascour-Sandoval, C., Muñoz-Poblete, C., & Marzuca-Nassr, G. N. (2022). The association of musculoskeletal complaints and individual and work-related factors with work ability in Chilean white-collar and blue-collar workers. International Journal of Occupational Safety and Ergonomics, 28(2), 1077-1084. https://doi.org/10.1080/10803548.2020.1865639

Tigora, A., Radu, P. A., Garofil, D. N., Bratucu, M. N., Zurzu, M., Paic, V., ... & Ramboiu, S. (2025). Modern perspectives on inguinal hernia repair: a narrative review on surgical techniques, mesh selection and fixation strategies. Journal of Clinical Medicine, 14(14), 4875. https://doi.org/10.3390/jcm14144875

Tobias, M., Vining, J., & Gaw, L. (2020). Risk factors for inguinal hernia: The role of obesity and chronic disease. Clinical Surgery Journal, 37(5), 1022–1030.

Vad, M. V, Frost, P., Bay-Nielsen, M., & Svendsen, S. W. (2012). Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair. Occupational and Environmental Medicine, 69(11), 802–809. https://doi.org/10.1136/oemed-2012-100787

Wahyuni, E. S. (2019). Hubungan berat beban terhadap tingkat kejadian nyeri punggung bawah pada pekerja buruh angkut Pasar Legi Surakarta. Interest: Jurnal Ilmu Kesehatan, 8(2), 158–161. https://doi.org/10.37341/interest.v8i2.170

Yangsap, A. (2025). The evaluation of the effectiveness of industrial back-support exoskeleton (BSEs) in caregiving activities (Doctoral dissertation, Loughborough University).