Prediction and Risk Evaluation for Surgical Intervention in Small Bowel Obstruction ^†.

Area of Science:

• Surgical Gastroenterology
• Abdominal Imaging
• Clinical Decision Support

Background:

• Small bowel obstruction (SBO) is a frequent surgical emergency with substantial morbidity and mortality.
• Effective management strategies require accurate prediction of surgical necessity.
• Current decision-making processes can be enhanced by objective risk stratification tools.

Purpose of the Study:

• To identify independent predictors for surgical intervention in patients with SBO.
• To develop and validate a simple clinical risk score for SBO management.
• To aid clinicians in distinguishing between surgical and conservative treatment pathways.

Main Methods:

• Retrospective analysis of 285 SBO patients treated between 2018 and 2022.
• Univariate and multivariate logistic regression to identify significant predictors of surgery.
• Development of a weighted risk score and evaluation using ROC analysis.

Main Results:

• Key predictors for surgery included prior abdominal operations, low serum albumin, free intraperitoneal fluid, air-fluid levels on X-ray, and CT transition point.
• A weighted risk score (0-6 points) demonstrated good discriminative performance (AUC 0.874).
• The score effectively stratified patients into low, intermediate, and high-risk groups for surgical intervention.

Conclusions:

• The identified predictors and developed risk score can assist in bedside decision-making for SBO.
• This tool may help optimize patient selection for surgery versus conservative management.
• Prospective multicenter validation is recommended prior to routine clinical implementation.