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Development and validation of a 30-day point-scoring risk calculator for small bowel obstruction surgery

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Abstract

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.

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Acknowledgements

The authors acknowledge Dr. Richard Amdur, PhD, for giving statistical support for this project.

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This research did not receive any funding from any agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA

    Renxi Li

  2. Department of Surgery, The George Washington University Hospital, Washington, DC, USA

    Renxi Li

  3. Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

    Renxi Li

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  1. Renxi Li
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Correspondence to Renxi Li.

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This study was exempt from the IRB approval by the George Washington University as it analyzed retrospective, deidentified ACS-NSQIP data.

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Li, R. Development and validation of a 30-day point-scoring risk calculator for small bowel obstruction surgery. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01875-7

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