Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction

BACKGROUND: Among patients with adhesive small bowel obstruction (ASBO) initially managed with a conservative strategy, predicting risk of operation is difficult. METHODS: We investigated ASBO patients at 2 different periods to derive and validate a clinical prediction model for risk of operation. RESULTS: One hundred fifty-four patients were enrolled into the derivation cohort and 96 into the validation cohort. Based on the derived scoring, including age >= 65 years, presence of ascites, and gastrointestinal drainage volume >500 mL on day 3, each patient was classified into 1 of 4 risk classes from low risk to high risk. When applied to the validation cohort, the positive predictive value (PPV) for operation in the high-risk class was 72%, while the negative predictive value (NPV) in the low-risk class was 100% with high sensitivity (100%) and specificity (96%). CONCLUSIONS: The prediction model performs well for risk stratification of need for surgical intervention following conservative strategy among ASBO patients. (C) 2010 Elsevier Inc. All rights reserved.