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Post-Operative Vital Sign Profiles Following Bowel Resection: A Comparison Based Upon Modality of Surgery
*Ryan Hendrix1, *Larson Erb2, *Lucy Greenberg2, *Turner Osler2, Neil Hyman3, Edward Borrazzo2
1University of Massachusetts Memorial Medical Center, Worcester, MA;2University of Vermont Medical Center, Burlington, VT;3University of Chicago Medical Center, Chicago, IL

OBJECTIVE: To evaluate the incidence of vital sign aberrations following laparoscopic bowel resection as compared with open bowel resection. We hypothesize that deviations in vital signs are less common and return to normal more quickly after laparoscopic surgery.
DESIGN: Retrospective case series of a prospectively maintained complication database. Data set generated by querying our electronic medical record (EPIC), and analyzed using commercially available statistical software (STATA).
SETTING: Tertiary-care academic medical center in Burlington, VT.
PATIENTS: 1,059 consecutive patients undergoing elective bowel resection with anastomosis from July 2009 to June 2014. Subjects were matched by age, gender, procedure code, tobacco abuse, diabetes, and cardiovascular disease
MAIN OUTCOME MEASURES: Vital signs and laboratory values (temperature, heart rate, respiratory rate, systolic blood pressure, and white blood cell count) on each post-operative day. A total of 170,642 vital signs and 4,868 WBC counts were measured and analyzed.
RESULTS: Of the total 1,059 patients who underwent bowel resection during the study period: 777 open cases (73.4%) and 282 laparoscopic cases (26.6%). Average vital signs and WBC counts were significantly lower after laparoscopic cases compared to open cases. All variables differed on post-operative day 1; temperature (p < .0001), heart rate (p < .0001), respirations (p < .0001), systolic blood pressure (p < .00817), and WBC count (p < .0001). By post-operative day 3, only heart rate differed amongst the groups (p < .0001), and by post-operative day 4, no significant differences remained.
CONCLUSIONS: Vital signs return to normal more quickly following laparoscopic procedures than after open procedures. Open surgery is more disruptive to baseline physiology, however, by post-operative day 3, physiologic differences between laparoscopic and open cases have largely resolved.


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