Published online Mar 7, 2023. doi: 10.3748/wjg.v29.i9.1509
Peer-review started: November 27, 2022
First decision: December 27, 2022
Revised: January 1, 2023
Accepted: February 15, 2023
Article in press: February 15, 2023
Published online: March 7, 2023
Processing time: 100 Days and 15.2 Hours
Small bowel obstruction (SBO) still imposes a substantial burden on the health care system. Traditional evaluation systems for SBO outcomes only focus on a single element. The comprehensive evaluation of outcomes for patients with SBO remains poorly studied. Early intensive clinical care would effectively improve the short-term outcomes for SBO, however, the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined.
We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status.
Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO (SiBO) group and the strangulated SBO (StBO) group. A principal component (PC) analysis was applied for data simplification and the extraction of patient characteristics, followed by separation of the high PC score group and the low PC score group. We identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management outcomes. Receiver operating characteristic curves were drawn, and the areas under the curve (AUCs) were calculated to assess the effectiveness of the predictive models.
Of the 281 patients, 45 patients (16.0%) were found to have StBO, whereas 236 patients (84.0%) had SiBO. Regarding standardized length of stay (LOS), total hospital cost and the presence of severe adverse events (SAEs), a novel principal component was extracted (PC score = 0.429 × LOS + 0.444 × total hospital cost + 0.291 × SAE). In the multivariate analysis, risk statuses related to poor results for SiBO patients, including a low lymphocyte to monocyte ratio (OR = 0.656), radiological features of a lack of small bowel feces signs (OR = 0.316) and mural thickening (OR = 1.338), were identified as risk factors. For the StBO group, higher BUN levels (OR = 1.478) and lower lymphocytes levels (OR = 0.071) were observed. The AUCs of the predictive models for poor outcomes were 0.715 (95%CI: 0.635-0.795) and 0.874 (95%CI: 0.762-0.986) for SiBO and StBO stratification, respectively.
The novel PC indicator provided a comprehensive scoring system for evaluating SBO outcomes on the foundation of complication-cost burden. According to the relative risk factors, early tailored intervention would improve the short-term outcomes.
Core Tip: A novel outcome indicator based on the standardized length of stay, total hospital cost and the presence of severe adverse events provided a comprehensive system for evaluating small bowel obstruction (SBO) outcomes. Furthermore, risk statuses associated with poor results were identified; specifically, for simple SBO patients, a low lymphocyte to monocyte ratio, as well as radiological features of a lack of small bowel feces signs and mural thickening, should be noticeable. For the strangulated SBO group, higher blood urea nitrogen levels and lower lymphocytes levels were recognized. Accordingly, early clinical intensive care was applicable for outcome improvement.