Predictive value of gastrointestinal decompression volume and its trajectory over time for surgical intervention in children with postoperative adhesive small bowel obstruction

Objective To investigate the predictive value of gastrointestinal decompression volume and its temporal trend for surgical intervention in children with postoperative adhesive small bowel obstruction (ASBO).Methods This retrospective study included 131 children with postoperative ASBO who initially received conservative treatment from January 2015 to December 2024. Based on treatment outcomes, patients were categorized into a successful conservative treatment group (CT, n = 80) and a surgical treatment group (ST, n = 51). Clinical data were collected, with emphasis on daily gastrointestinal decompression volume and its changes during conservative treatment. To account for weight differences, the unit weight gastrointestinal decompression volume (mL/kg) was adopted as the main variable. Generalized estimating equations (GEEs) were used to analyze dynamic trends. Predictive performance was evaluated using univariate binary logistic regression and receiver operating characteristic (ROC) curve analyses.Results From Day 1, GEE analysis showed a significant interaction between time and group (p = 0.049). The CT group showed a rapid decrease in unit weight gastrointestinal decompression volume (p < 0.001), whereas the ST group exhibited a slower decline. The ST group had significantly higher volumes than the CT group from Days 1–3. Decompression volumes on Days 1 and 2 were identified as significant predictors of surgery. Area under the curve values for predicting surgical need were 0.705 and 0.718 on Days 1 and 2, and the corresponding optimal cutoff values were 11.5 and 13.9 mL/kg, respectively.Conclusion Unit weight gastrointestinal decompression volume and its trajectory may serve as useful predictors of the need for surgical treatment in pediatric postoperative ASBO.