Is my ASBO patient going to need surgery? Predicting conservative treatment failure for ASBO at admission

Introduction

Standard care for adhesive small bowel obstruction (ASBO) is non-operative management in absence of signs of complication. The use of water-soluble contrast challenge in the work-up of these patients is widely use, being highly indicative of failure of conservative management if it doesn"t reach the colon within 24 hours. However, predicting this failure at admission would avoid delay in needed surgical management and potential complications.

Material & Methods

Analysis of a prospective database of patients admitted to the emergency department with a diagnosis of ASBO from January 1st 2022 to October 31st 2023. A univariate analysis was carried out for variables associated with surgery during admission. Variables with p value < 0.20 were considered in the creation of the multivariate model. The model was chosen according to Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and the Area Under the Curve (AUC).

Results

41 of 130 patients (31.54%) finally required surgery during admission. Female sex (OR 1.70, p=0.160), TCScore (presence of free liquid [1 point] + bowel wall lack of enhancement [1 point], 1pt OR 2.26, 2pt OR 6.71, p=0,011), previous episode resolved with conservative treatment (OR 0.32, p=0.020), previous abdominal surgery (OR 0.35, p=0,019) and the presence of abdominal pain (OR 6.84, p=0.020) were considered for multivariate analysis. 31 possible submodels were created, choosing the model composed of the presence of previous episode resolved with conservative management, TCScore and presence of abdominal pain (AIC=152.0, BIC 166.4, AUC 0.720, p<0.001,).

Conclusions

This model can help to identify patients with ASBO that are likely to fail conservative treatment and that may undergo surgery, avoiding delay and complications.

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