Abnormal Vital Signs Are Common after Bowel Resection and Do Not Predict Anastomotic Leak

Abstract

Anastomotic leak is a serious complication of gastrointestinal surgery. Abnormal vital signs are often cited in retrospective peer review and medicolegal settings as evidence of negligence in the failure to make an early diagnosis. We aimed to profile the postoperative courses of patients who undergo intestinal anastomosis and determine how reliably abnormal vital signs predict anastomotic leaks. Consecutive patients undergoing bowel resection with anastomosis at an academic medical center from July 2009 through July 2011 were identified from a prospective complication database. The electronic medical record was queried for postoperative vital signs and laboratory studies, which were digitally abstracted. Abnormal values were defined as temperature >38°C, white blood cell count ≤4,000 or ≥12,000 cells/uL, systolic blood pressure ≤80mmHg or diastolic blood pressure ≤50 mmHg, pulse ≥100 beats per minute, and respiratory rate ≥20 breaths per minute. Patients who developed an anastomotic leak were compared with those with an uncomplicated postoperative course. Of the 452 patients, 141 (31.2%) suffered a total of 271 complications, including 19 anastomotic leaks. Even in "uncomplicated" recoveries, tachycardia and tachypnea were almost routine, occurring in more than half of the patients frequently throughout the postoperative period. Hypotension, fever, and leukocytosis were also remarkably common. The positive predictive value of any aberrant vital sign or white blood cell count ranged between 4% and 11%. Abnormal vital signs are extremely common after bowel resection with anastomosis. Even sustained aberrant vital signs and/or leukocytosis are not necessarily suggestive of a leak or other postoperative complication.