Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2023; 29(9): 1509-1522
Published online Mar 7, 2023. doi: 10.3748/wjg.v29.i9.1509
Comprehensively evaluate the short outcome of small bowel obstruction: A novel medical-economic score system
Wei-Xuan Xu, Qi-Hong Zhong, Yong Cai, Can-Hong Zhan, Shuai Chen, Hui Wang, Peng-Sheng Tu, Wen-Xuan Chen, Xian-Qiang Chen, Jun-Rong Zhang
Wei-Xuan Xu, Qi-Hong Zhong, Yong Cai, Can-Hong Zhan, Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350122, Fujian Province, China
Shuai Chen, Hui Wang, Peng-Sheng Tu, Wen-Xuan Chen, Xian-Qiang Chen, Jun-Rong Zhang, Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Xu WX designed and performed the research and drafted the manuscript; Zhang JR designed the research and supervised and reviewed the report; Chen XQ supervised the report and provided funding acquisition; Zhong QH, Cai Y, Zhan CH, designed the research and contributed to the analysis; Chen WX, Chen S, Wang H, Tu PS collected data and provided methodology.
Supported by Joint Funds for the innovation of science and Technology, Fujian Province, No. 2018Y9054; Young and Middle-Aged Talents Backbone Program of Fujian Province, No. 2020GGA034; The Construction Project of Fujian Province Minimally Invasive Medical Center, No. [2021]76.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Fujian Medical University Union Hospital (Approval No. 2021YF005-02).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors read and approved the final manuscript and declared no conflicts of interest.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at junrongzhang@fjmu.edu.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Rong Zhang, MD, Attending Doctor, Chief Doctor, Surgeon, Surgical Oncologist, Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. junrongzhang@fjmu.edu.cn
Received: November 27, 2022
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
Abstract
BACKGROUND

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.

AIM

We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Principal component analysis; Small bowel obstruction; Outcome evaluation system; Risk factors; Intensive clinical care; Radiomics

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.