Development of a predictive model for the need for early surgery in patients with adhesive small-bowel obstruction

ObjectiveTo develop a predictor of early surgical intervention in patients with adhesive small-bowel obstruction (ASBO), to optimise treatment strategies and improve patient outcomes.MethodsA retrospective analysis was conducted of patients with ASBO between August 2019 and June 2024. Clinical, laboratory and imaging data were analysed. A scoring system was developed using C-reactive protein (CRP) concentration, white blood cell (WBC) count, body mass index (BMI), and imaging findings.ResultsThe developed ASBO surgical score predicted the need for early surgery with a sensitivity of 89.6%, a specificity of 87.3%, and an area under the curve of 0.88. Patients with a score of 5 to 7 were significantly more likely to require surgical management: 75% of these patients underwent surgery, versus 4.2% in the Conservative treatment group. Key predictors of the need for surgery were high CRP concentration (>54.3 nmol/L), high WBC count (>11.0 × 10⁹/L), BMI <22 kg/m², maximum small intestinal diameter on computed tomography images >3.85 cm, and free fluid in the abdominal cavity.ConclusionsThe ASBO surgical score is a practical tool that should aid in the timely identification of patients requiring surgical intervention, and may reduce the risk of complications and improve the outcomes of patients.