Are the systemic immune-inflammation index and panimmune-inflammation value predictive indicators for the decision of operative treatment in adhesive small bowel obstruction?

Abstract

Background: Emergency surgical pathologies constitute a significant portion of general surgery practice. Small bowel obstructions are a common cause of surgical emergencies in general surgical practice. This study aimed to investigate the predictive role of the Systemic Immune-Inflammation Index and Pan-Immune-Inflammation Value in determining the need for operative treatment in adhesive small bowel obstructions. These obstructions are significant in general surgery, yet clinicians lack consensus on treatment selection and clinical follow-up. This study also seeks to address controversial questions surrounding this topic.

Methods: The study included patients with small bowel obstruction caused by adhesions during the postoperative period who were treated and followed up in our General Surgery Clinic. Patients' age, demographic information, and clinical data from January 2017 to January 2024 were retrospectively reviewed and recorded using the hospital information management system (HIMS) and patient records. Statistical analyses were performed using SPSS version 22.0.

Results: A total of 341 patients with postoperative adhesive small bowel obstruction were included in the study. The mean age was 59.6+-17.4 years (range: 18-93 years), with a male-to-female ratio of 1.4: 1. The median duration of symptoms was 2 days (range: 1-30 days). Operative treatment was performed in 19.6% of cases. The most frequently used operative technique was explorative laparotomy and bridectomy (70.1%). Intensive care unit (ICU) admission was required for 16.1% of patients, and the in-hospital mortality rate was 4.1%. The predictive roles of the Systemic Immune-Inflammation Index (SII), Pan-Immune-Inflammation Value (PIV), and other markers for operative treatment were evaluated. Receiver operating characteristic (ROC) analysis revealed that SII (area under the curve [AUC]=0.601, p=0.009) and PIV (AUC=0.596, p=0.010) were determinants for operative treatment.

Conclusion: SII and PIV values may assist in determining the need for operative treatment or non-operative follow-up in patients with adhesive small bowel obstruction (ASBO). By utilizing these markers, unnecessary operative interventions may be avoided. The management strategies for ASBO, a significant component of general surgical emergency practice, remain to be fully clarified. There are ongoing debates in the literature on this subject. We believe further studies with prospective, homogeneous, and broader populations should be conducted to address this issue.