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Assessing risk of recurrent small bowel obstruction after non-operative management in patients with history of intra-abdominal surgery: a population-based comprehensive analysis in Taiwan

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Abstract

Background

Despite a significant 30% ten-year readmission rate for SBO patients, investigations into recurrent risk factors after non-operative management are scarce. The study aims to generate a risk factor scoring system, the ‘Small Bowel Obstruction Recurrence Score’ (SBORS), predicting 6-month recurrence of small bowel obstruction (SBO) after successful non-surgical management in patients who have history of intra-abdominal surgery.

Methods

We analyzed data from patients aged ≥ 18 with a history of intra-abdominal surgery and diagnosed with SBO (ICD-9 code: 560, 568) and were successful treated non-surgically between 2004 and 2008. Participants were divided into model-derivation (80%) and validation (20%) group.

Results

We analyzed 23,901 patients and developed the SBORS based on factors including the length of hospital stay > 4 days, previous operations > once, hemiplegia, extra-abdominal and intra-abdominal malignancy, esophagogastric surgery and intestino-colonic surgery. Scores > 2 indicated higher rates and risks of recurrence within 6 months (12.96% vs. 7.27%, OR 1.898, p < 0.001 in model-derivation group, 12.60% vs. 7.05%, OR 1.901, p < 0.001 in validation group) with a significantly increased risk of mortality and operative events for recurrent episodes. The SBORS model demonstrated good calibration and acceptable discrimination, with an area under curve values of 0.607 and 0.599 for the score generation and validation group, respectively.

Conclusions

We established the effective ‘SBORS’ to predict 6-month SBO recurrence risk in patients who have history of intra-abdominal surgery and have been successfully managed non-surgically for the initial obstruction event. Those with scores > 2 face higher recurrence rates and operative risks after successful non-surgical management.

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Data availability

The data utilized in this study cannot be made available in the manuscript, supplemental files, or a public repository due to the “Personal Information Protection Act” executed by Taiwan’s government, which took effect in 2012. Requests for data can be sent as a formal proposal to the NHIRD (http://nhird.nhri.org.tw) or via email to nhird@nhri.org.tw.

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Acknowledgements

This study is partly based on data from the National Health Insurance Research Database (NHIRD), provided by the National Health Insurance Administration of the Ministry of Health and Welfare and managed by the National Health Research Institutes (Registration Number NHIRD-103-246).

Funding

This work was supported by the E-da Hospital Research Foundation (EDAHC-111-003, EDAHP-111-007, EDAHP-111-021, EDAHP-111-018, EDAHS-111-020, EDAHP-112-005, EDAHP-112-010, EDAHC-112-001).

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Author notes

  1. Pin-Chun Chen and Shang-Wei Lin have contributed equally as the first authors.

  2. Hung-Yu Lin and Jian-Han Chen have contributed equally as the corresponding authors.

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan

    Shang-Wei Lin

  2. Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan

    Chung-Yen Chen, Che-Lun Feng & Jian-Han Chen

  3. Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan

    Chung-Yen Chen & Jian-Han Chen

  4. School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan

    Chung-Yen Chen, Pin-Chun Chen, Hung-Yu Lin & Jian-Han Chen

  5. Division of Colon & Rectal Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan

    Pin-Chun Chen

  6. Division of Urology, Department of Surgery, E-Da Cancer & E-Da Hospital, Kaohsiung, Taiwan

    Hung-Yu Lin

  7. Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan

    Shang-Wei Lin

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Lin, SW., Chen, CY., Chen, PC. et al. Assessing risk of recurrent small bowel obstruction after non-operative management in patients with history of intra-abdominal surgery: a population-based comprehensive analysis in Taiwan. Surg Endosc 38, 2433–2443 (2024). https://doi.org/10.1007/s00464-024-10746-6

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