The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
Department of Surgery, The George Washington University Hospital, Washington, DC, USA.
Updates Surg. 2024 Oct;76(6):2293-2302. doi: 10.1007/s13304-024-01875-7. Epub 2024 May 10.
Small bowel obstruction (SBO) is one of the most frequent causes of general emergency surgery. The 30-day mortality rate post-surgery ranges widely from 2 to 30%, contingent upon the patient population, which renders risk assessment tools helpful. this study aimed to develop a 30-day point-scoring risk calculator designed for patients undergoing SBO surgery. Patients who underwent SBO surgery were identified in the ACS-NSQIP database from 2005 to 2021. Patients were randomly sampled into an experimental (2/3) and a validation (1/3) group. A weighted point scoring system was developed for the risk of 30-day mortality, utilizing multivariable regression on preoperative risk variables based on Sullivan's method. The risk scores underwent both internal and external validation. Furthermore, the efficacy of the risk score was evaluated in 30-day major surgical complications. A total of 93,517 patients were identified, with 63,521 and 29,996 assigned to the experimental and validation groups, respectively. The risk calculator is structured to assign points based on age (> 85 years, 4 points; 75-85 years, 3 points; 65-75 years, 2 points; 55-65 years, 1 point), disseminated cancer (2 points), American Society of Anesthesiology (ASA) score of 4 or 5 (1 point), preoperative sepsis (1 point), hypoalbuminemia (1 point), and fully dependent functional status (1 point). The risk calculator showed strong discrimination (c-statistic = 0.825, 95% CI 0.818-0.831) and good calibration (Brier score = 0.043) in the experimental group. The point scoring system was successfully translated from individual preoperative variables (c-statistic = 0.840, 95% CI 0.834-0.847) and was externally validated in ACS-NSQIP (c-statistic = 0.827, 95% = CI 0.834-0.847, Brier score = 0.043). The SBO risk score can effectively discriminate major surgical complications including major adverse cardiovascular events (c-statistic = 0.734), cardiac complications (c-statistic = 0.732), stroke (c-statistic = 0.725), pulmonary complications (c-statistic = 0.727), renal complications (c-statistic = 0.692), bleeding (c-statistic 0.674), sepsis (c-statistic = 0.670), with high predictive accuracy (all Brier scores < 0.1). This study developed and validated a concise yet robust 10-point risk scoring system for patients undergoing SBO surgery. It can be informative to determine treatment plans and to prepare for potential perioperative complications in patients undergoing SBO surgery.
小肠梗阻 (SBO) 是普通急症外科最常见的原因之一。手术后 30 天的死亡率范围很广，从 2%到 30%不等，这取决于患者人群，这使得风险评估工具很有帮助。本研究旨在为接受 SBO 手术的患者开发一个 30 天的点评分风险计算器。
从 2005 年到 2021 年，ACS-NSQIP 数据库中确定了接受 SBO 手术的患者。患者被随机分为实验（2/3）和验证（1/3）组。基于 Sullivan 方法，利用术前风险变量的多变量回归，为 30 天死亡率风险制定了加权评分系统。风险评分进行了内部和外部验证。此外，还评估了风险评分在 30 天主要手术并发症方面的效果。
共确定了 93517 名患者，其中 63521 名和 29996 名患者分别被分配到实验组和验证组。风险计算器的结构是根据年龄（>85 岁，4 分；75-85 岁，3 分；65-75 岁，2 分；55-65 岁，1 分）、播散性癌症（2 分）、美国麻醉师协会（ASA）评分 4 或 5（1 分）、术前脓毒症（1 分）、低蛋白血症（1 分）和完全依赖功能状态（1 分）来分配分数。
风险计算器在实验组中显示出较强的区分度（c 统计量=0.825，95%CI 0.818-0.831）和良好的校准度（Brier 得分=0.043）。该评分系统成功地从个体术前变量（c 统计量=0.840，95%CI 0.834-0.847）中进行了翻译，并在 ACS-NSQIP 中进行了外部验证（c 统计量=0.827，95%CI=0.834-0.847，Brier 得分=0.043）。SBO 风险评分可有效区分包括主要不良心血管事件（c 统计量=0.734）、心脏并发症（c 统计量=0.732）、中风（c 统计量=0.725）、肺部并发症（c 统计量=0.727）、肾脏并发症（c 统计量=0.692）、出血（c 统计量 0.674）、脓毒症（c 统计量=0.670）在内的主要手术并发症，具有较高的预测准确性（所有 Brier 评分均<0.1）。
本研究开发并验证了一种针对接受 SBO 手术患者的简洁而强大的 10 分风险评分系统。它可以为接受 SBO 手术的患者提供有价值的信息，以确定治疗计划并为潜在的围手术期并发症做好准备。
