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This retrospective study aimed to identify robust predictors for the need for surgery and to build an easy bedside risk score to support treatment decisions. Data from 285 SBO patients (2018–2022) at University Hospital Erlangen were analyzed with univariate and multivariate logistic regression, followed by ROC-based discrimination assessment. 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Weber , Robert Grützmann, Maximilian Brunner ‡ and Anke Mittelstädt ‡  \nAcademic Editor: Jun Kato  \nReceived: 3 December 2025  \nRevised: 26 December 2025  \nAccepted: 28 December 2025  \nPublished: 30 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDepartment of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstrasse 12, 91054 Erlangen, Germany  \n* Correspondence: timur.buniatov@uk-erlangen.de  \n† The present work was performed in partial fulfillment of the requirements for obtaining the degree of“[Dr. med](Dr. med).” at Friedrich-Alexander-Universität Erlangen-Nürnberg by Timur Buniatov.  \n‡ These authors contributed equally to this work.  \nAbstract  \nBackground/Objectives: Small bowel obstruction (SBO) is a common surgical emergency associated with significant morbidity and mortality. This retrospective analysis aimed to identify key predictors for the need for surgery in SBO management and to develop a simple clinical risk score to support decision-making. Methods: This retrospective study included 285 patients treated for SBO at the University Hospital Erlangen from 2018 to 2022. Pretherapeutic clinical, laboratory, and imaging data, as well as treatment details and outcome parameters were assessed and analyzed using univariate and multivariate logistic regression to identify significant predictors for the need of surgery. A weighted point-based risk score was then derived from the final model, and its discriminative performance was evaluated using receiver operating characteristic (ROC) analysis. Results: Of the 285 patients, 234 (82.1%) underwent surgery and 51 (17.9%) were successfully managed conservatively. Multivariate analysis identified the following independent predictors for surgery: 0–1 previous abdominal operation (OR 4.7, p = 0.009), serum albumin ≤ 34 g/L (OR 4.5, p = 0.011), free intraperitoneal fluid on imaging (OR 3.6, p = 0.015), air–fluid levels on plain abdominal X-ray (OR 3.5, p = 0.024) and a transition point on CT (OR 11.4, p = 0.002) . A weighted score (range 0–6 points) was constructed, assigning 1 point to each of the first four predictors and 2 points to the transition point. The score showed good discrimination for predicting the need for surgery (AUC 0.874) . Using a cut-off of ≥3 points, sensitivity was 96.2% and specificity 64.7% . The observed proportion of patients requiring surgery increased from 21.4% in the low-risk group (0–2 points) to 88.6% in the intermediate-risk group (3–4 points) and 97.3% in the high-risk group (5–6 points) . Conclusions: The proposed predictors and the weighted risk score may support bedside decision-making in SBO by distinguishing patients who require surgery from those eligible for conservative management, but they require prospective multicenter validation before routine clinical implementation.  \nKeywords: SBO; ileus; emergency; prediction; surgery  \n1. Introduction  \nMechanical small bowel obstruction (SBO) is a critical surgical condition requiring prompt and effective management to prevent severe complications such as bowel ischemia, necrosis, dehydration and aspiration [1] . Morbidity and mortality are particularly high  \nin cases of perforation, with reported mortality rates reaching up to 30% if complications develop [2] .  \nIn Germany, approximately 110,000 patients are hospitalized annually for ileus, with an incidence of 108 per 100,000 individuals [3] . SBO accounts for nearly 15% of all surgical admissions from emergency departments and over 20% of these cases require surgical intervention [4,5] . T","cbCaitu7WKDllt7i","https://ap.wps.com/l/cbCaitu7WKDllt7i","pdf",663614,14,"English","# Abstract\n# 1. Introduction","[{\"question\":\"What was the study’s main goal in SBO management?\",\"answer\":\"To identify key predictors for whether patients with small bowel obstruction require surgery and to develop a simple weighted risk score to support decision-making.\"},{\"question\":\"How were predictors and the risk score derived in this study?\",\"answer\":\"Pretherapeutic clinical, laboratory, and imaging data were analyzed using univariate and multivariate logistic regression; a weighted point-based risk score was then created from the final model and evaluated with ROC analysis.\"},{\"question\":\"Which factors independently predicted the need for surgery?\",\"answer\":\"Independent predictors included a history of 0–1 previous abdominal operation, serum albumin ≤34 g/L, free intraperitoneal fluid on imaging, air–fluid levels on plain abdominal X-ray, and a transition point on CT.\"}]","Prediction and Risk Evaluation for Surgical Intervention in Small Bowel Obstruction | PDF",1790761508,35]