Abstract：
BACKGROUND: Postoperative adhesions are frequent and significant complications that typically arise following abdominal surgery. Currently, the existing evidence for predicting the risk of adhesive small bowel obstruction (ASBO) after emergency gastrointestinal surgery (EGS) remains inadequate. A reliable perioperative model that quantifies the risk of ASBO after EGS serves as a practical tool for guiding individually tailored surveillance.
METHODS: A consecutive series of 1296 patients who underwent EGS for radiologically confirmed bowel/visceral inflammation or perforation between 2012 and 2022 at a tertiary academic medical center were included in this study to establish a best-fit nomogram. The nomogram was externally validated by assessing discrimination and calibration using an independent cohort from a separate medical center.
RESULTS: A total of 116 patients (8.9%) developed at least one episode of ASBO after EGS during a median follow-up duration of 26 months. The results of multivariable logistic analysis indicated that male sex (P = 0.043), preoperative albumin level (P = 0.002), history of pelvic radiotherapy (P = 0.038), laparotomy (P = 0.044), and intensive care unit stay ≥ 72 h (P = 0.047) were identified as independent risk factors for developing ASBO. By incorporating these predictors, the developed nomogram exhibited good accuracy in risk estimation, as evidenced by a guide-corrected C-index score of 0.852 (95% CI 0.667-0.920) in the external validation cohort. Decision curve analysis and clinical impact curve demonstrated a clinically effective predictive model.
CONCLUSIONS: By incorporating the nomogram as a supplemental tool in perioperative management, it becomes possible to accurately assess the individual\'s likelihood of developing ASBOs. This quantification enables surgeons to implement appropriate preventive measures, ultimately leading to improved outcomes.
METHODS: A consecutive series of 1296 patients who underwent EGS for radiologically confirmed bowel/visceral inflammation or perforation between 2012 and 2022 at a tertiary academic medical center were included in this study to establish a best-fit nomogram. The nomogram was externally validated by assessing discrimination and calibration using an independent cohort from a separate medical center.
RESULTS: A total of 116 patients (8.9%) developed at least one episode of ASBO after EGS during a median follow-up duration of 26 months. The results of multivariable logistic analysis indicated that male sex (P = 0.043), preoperative albumin level (P = 0.002), history of pelvic radiotherapy (P = 0.038), laparotomy (P = 0.044), and intensive care unit stay ≥ 72 h (P = 0.047) were identified as independent risk factors for developing ASBO. By incorporating these predictors, the developed nomogram exhibited good accuracy in risk estimation, as evidenced by a guide-corrected C-index score of 0.852 (95% CI 0.667-0.920) in the external validation cohort. Decision curve analysis and clinical impact curve demonstrated a clinically effective predictive model.
CONCLUSIONS: By incorporating the nomogram as a supplemental tool in perioperative management, it becomes possible to accurately assess the individual\'s likelihood of developing ASBOs. This quantification enables surgeons to implement appropriate preventive measures, ultimately leading to improved outcomes.
摘要：
背景：术后粘连是腹部手术后常见且严重的并发症。目前,预测急诊胃肠手术(EGS)后粘连性小肠梗阻(ASBO)风险的现有证据仍然不足.量化EGS后ASBO风险的可靠围手术期模型可作为指导个性化监测的实用工具。
方法：本研究纳入了2012年至2022年间在三级学术医学中心接受EGS治疗的1296例经放射学证实为肠/内脏炎症或穿孔的连续系列患者，以建立最适合的列线图。通过使用来自独立医疗中心的独立队列评估辨别和校准来外部验证列线图。
结果：共有116例患者（8.9%）在中位26个月的随访期间，在EGS后至少发生了一次ASBO发作。多因素Logistic分析结果显示男性(P=0.043),术前白蛋白水平(P=0.002),盆腔放疗史（P=0.038），开腹手术（P=0.044），重症监护病房住院时间≥72h(P=0.047)是发生ASBO的独立危险因素。通过结合这些预测因子，开发的列线图在风险估计中表现出良好的准确性，如在外部验证队列中指南校正的C指数评分0.852(95%CI0.667-0.920)所证明.决策曲线分析和临床影响曲线证明了临床有效的预测模型。
结论：将列线图作为围手术期管理的补充工具，准确评估个体发展ASBO的可能性成为可能。这种量化使外科医生能够实施适当的预防措施，最终导致改善的结果。
方法：本研究纳入了2012年至2022年间在三级学术医学中心接受EGS治疗的1296例经放射学证实为肠/内脏炎症或穿孔的连续系列患者，以建立最适合的列线图。通过使用来自独立医疗中心的独立队列评估辨别和校准来外部验证列线图。
结果：共有116例患者（8.9%）在中位26个月的随访期间，在EGS后至少发生了一次ASBO发作。多因素Logistic分析结果显示男性(P=0.043),术前白蛋白水平(P=0.002),盆腔放疗史（P=0.038），开腹手术（P=0.044），重症监护病房住院时间≥72h(P=0.047)是发生ASBO的独立危险因素。通过结合这些预测因子，开发的列线图在风险估计中表现出良好的准确性，如在外部验证队列中指南校正的C指数评分0.852(95%CI0.667-0.920)所证明.决策曲线分析和临床影响曲线证明了临床有效的预测模型。
结论：将列线图作为围手术期管理的补充工具，准确评估个体发展ASBO的可能性成为可能。这种量化使外科医生能够实施适当的预防措施，最终导致改善的结果。
