Impact of surgery and complications on GI recovery after SBO: Insights from the SnapSBO cohort

Background: Small bowel obstruction (SBO) is a common surgical emergency associated with impaired gastrointestinal (GI) function and prolonged recovery. The PRO-diGI patient-reported outcome measure (PROM) assesses patients' reports on key domains of appetite, nausea, bowel function, well-being and overall GI function. This study evaluated the influence of demographic and treatment factors on GI recovery following SBO and examined whether these associations persisted after balancing for baseline differences using propensity score matching (PSM). Methods: An international prospective multicentre cohort study enrolled adult patients undergoing treatment for SBO of any aetiology. GI recovery was assessed using the PRO-diGI tool. Multivariable regression models were used to identify associations between clinical factors and PROM scores. Regression coefficients (β) with 95% confidence intervals were calculated. PSM was performed within the adhesional SBO subgroup to minimize confounding from differences in follow-up time and baseline characteristics. Results: Of 1734 participants, 644 completed all PROM domains. Among patients contributing PROM data, surgical intervention was associated with improved nausea (β 5.9, 95% confidence interval 1.1-11.0) and overall GI function (β 6.8, 95% confidence interval 0.54-13.0) scores. Complications were linked to worse nausea (β -9.3, 95% confidence interval -17.0 to -1.7), well-being (β -17.0, 95% confidence interval -29.0 to -4.3), and overall function (β -12.0, 95% confidence interval -22.0 to -1.4). Previous nonoperative SBO episodes were associated with reduced appetite scores (β -7.3, 95% confidence interval -13.0 to -1.7). In the adhesion PSM cohort, overall GI function remained higher after surgery, and laparoscopic adhesiolysis was associated with superior appetite and overall function scores. Discussion: Surgical treatment without complications was associated with improved patient-reported GI recovery after SBO. Persistence of these associations following matching indicates that patient-reported GI recovery differs across treatment pathways in selected patients, supporting the feasibility and discriminatory value of PRO-diGI as a patient-centred outcome measure.