Published online Mar 7, 2023. doi: 10.3748/wjg.v29.i9.1509
Peer-review started: November 27, 2022
First decision: December 27, 2022
Revised: January 1, 2023
Accepted: February 15, 2023
Article in press: February 15, 2023
Published online: March 7, 2023
Small bowel obstruction (SBO) still imposes a substantial burden on the health care system. Traditional evaluation systems for SBO outcomes only focus on a single element. There is still lack of an integrative medical-economic system to evaluate the overall outcomes for SBO. Moreover, patients’ statuses on admission, including longer pain duration, acute kidney injury and malnutrition, were found to be closely correlated with severe adverse events (SAEs). However, the risk factors for the integrative scoring system, including clinical and economic adverse events, have not been extensively evaluated.
SBO still imposes a substantial burden on the health care system. Traditional evaluation systems for SBO outcomes only focus on a single element. The comprehensive evaluation of outcomes for patients with SBO remains poorly studied. Early intensive clinical care would effectively improve the short-term outcomes for SBO, however, the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined.
In this study, we aim to construct a novel indicator combining standardized SAEs, length of stay (LOS) and total hospital cost for defining outcomes of SBO. Furthermore, we established a representative model for distinguishing high-risk statuses on admission for the simple SBO (SiBO) or strangulated SBO (StBO) groups. Given that SBO still imposes a substantial burden on the health care system, we believe our findings will provide a new insight for comprehensively evaluation outcomes of SBO as well as a guideline for early intervention.
In this study, we evaluated posttreatment outcomes of SBO both clinically and economically. Principal component analysis (PCA) was used to achieve data simplification by expressing multivariate outcome indicators with fewer dimensions. By summarizing and maximizing the information encoding in standardized LOS, total hospital cost and the presence of SAEs, a novel principal component was extracted: PC score = 0.429 × LOS + 0.444 × total hospital cost + 0.291 × SAE. Furthermore, the patient population was classified in the following manner according to the quartile PC score: The low PC score group (below the 75% quartile) and the high PC score group (in the upper 75% quartile).
In this study, a novel outcome indicator based on the standardized LOS, total hospital cost and the presence of SAEs provided a comprehensive system for evaluating SBO outcomes (PC score = 0.429 × LOS + 0.444 × total hospital cost + 0.291 × SAE). Furthermore, risk statuses associated with poor results were identified; specifically, for SiBO patients, a low LMR, as well as radiological features of a lack of small bowel feces signs and mural thickening, should be noticeable. For the StBO group, higher blood urea nitrogen levels and lower lymphocytes levels were recognized. Accordingly, early clinical intensive care was applicable for outcome improvement. In the future, adequately powered and well-designed studies are required to confirm these findings and to establish causality.
In this study, PCA was innovatively used for dimension reduction, linear correlation resolution and data simplification. Furthermore, a novel comprehensive system for the evaluation of SBO outcomes was constructed and the potential risk status associated with poor results were identified.
Large-scale and prospective studies are going to be designed to confirm these findings and to establish causality.