Objective To explore the risk factors affecting operation treatment selection of acute adhesive small bowel obstruction (ASBO), and establish a prediction model of surgical treatment selection to provide a guidance for clinical decision-making. Methods The patients with acute ASBO admitted to this hospital and met the inclusion and exclusion criteria, from January 2019 to December 2022, were retrospectively collected, and the patients were assigned into the surgical treatment and conservative treatment according to the treatment selection. The differences in the clinicopathologic factors between the patients with surgical treatment and conservative treatment were compared. Meanwhile, the factors with statistical differences (P<0.05) or the factors with clinical significance judged based on professional knowledge were included to screen the influencing factors of surgical treatment selection using the multivariate logistic regression analysis, and the selected influencing factors were used to construct the logistic regression prediction model equation. The area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (95%CI) was used to evaluate the prediction efficiency of the prediction model equation. Results A total of 231 patients with acute ASBO were included, 117 (50.6%) of whom underwent surgical treatment and 114 (49.4%) underwent conservative treatment. In all 16 clinicopathologic factors between the patients with surgical treatment and conservative treatment had statistical differences (P<0.05) including the body mass index (BMI), preopeative high fever, intestinal type, sign of peritonitis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score excluded age scoring, abdominal surgery history and times of abdominal surgery history, times of pre-admission seek medical advice and preoperative conservative treatment time, the air-liquid level by X-ray plain film, and severe small bowel obstruction and adhesive bands by CT examination, as well as the white blood cell count (WBC), neutrophil percentage, albumin (ALB), and urea nitrogen. The multivariate logistic regression analysis showed that the acute ASBO accompanied by sign of peritonitis (β=1.778, P=0.028), history of abdominal surgery (β=1.394, P=0.022), and adhesive bands (β=1.321, P=0.010) and severe small bowel obstruction (β=1.183, P=0.018) by CT examination, WBC (β=0.524, P＜0.001), APACHEⅡ score excluded age scoring (β=0.291, P＜0.001), and BMI (β=0.191, P=0.011) had positive impacts on adopting surgical treatment, while preoperative ALB (β=–0.101, P=0.023) and conservative treatment time (β=–0.391, P＜0.001) had negative impacts on adopting surgical treatment. The accuracy, specificity, and sensitivity of the logistic regression prediction model equation constructed according to these 9 influencing factors were 84.8%, 71.1%, and 77.7%, respectively. The AUC (95%CI) of the prediction model equation to distinguish selection of surgical treatment from conservative treatment was 0.942 (0.914, 0.970). Conclusions According to the preliminary results of this study, surgical treatment is recommended for patients with acute ASBO accompanied by signs of peritonitis, history of abdominal surgery, adhesive bands and severe small bowel obstruction by CT, increased preoperative WBC, high APACHEⅡ score excluded age scoring, high BMI, preoperative low ALB level, and shorter preoperative conservative treatment time. And the logistic prediction model equation constructed according to these characteristics in this study has a good discrimination for patients with surgical treatment or conservative treatment selection.

Citation： WANG Zezheng, LIU Zhekui, MA Wenxing, LIU Sida, WU Yunhua, DUAN Xianglong. Prediction model of surgical treatment selection for acute adhesive small intestinal obstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(10): 1217-1223. doi: 10.7507/1007-9424.202306029 Copy