Clinical profile and factors associated with adverse surgical management outcome among patients with adhesive bowel obstruction at selected hospitals in Uganda

Background Adhesive bowel obstruction is an important cause of small bowel obstruction and remains a common emergency surgical condition. Although stable patients may initially be managed non-operatively, surgery is required when obstruction fails to resolve or when ischemia, strangulation, or peritonitis is suspected. In Uganda, evidence on surgically managed adhesive bowel obstruction remains limited. This study described the clinical profile, 30-day adverse surgical outcomes, and factors associated with adverse outcomes among patients undergoing surgery for adhesive bowel obstruction at selected regional referral hospitals in Uganda. Methods A prospective cohort study was conducted at Hoima, Fort Portal, Jinja, and Kayunga Regional Referral Hospitals. Patients with clinical, radiological, and intraoperative diagnosis of adhesive bowel obstruction who underwent surgery were consecutively enrolled and followed for 30 days. The primary outcome was any adverse surgical outcome within 30 days, defined as surgical site infection, prolonged postoperative ileus, mortality, or prolonged hospital stay. Data were analyzed using SPSS version 26. Descriptive statistics summarized participant characteristics and outcomes. Bivariate and multivariable Poisson regression analyses were performed to identify factors associated with adverse surgical outcomes. Results Seventy patients were included. The largest age group was 35–50 years (41.4%), and 38 participants (54.3%) were female. Previous abdominal surgery was reported in 59 participants (84.3%). The commonest previous operations were appendectomy (22.9%), cholecystectomy (21.4%), and gastric bypass (17.1%). Most participants had undergone their initial operation more than five years before presentation (65.7%). Abdominal pain was the commonest presenting symptom (77.1%). Intraoperatively, adhesions were found in 48.6%, while bowel ischemia was present in 30.0%. Overall, 28 participants (40.0%) developed at least one adverse surgical outcome. On multivariable Poisson regression, age above 51 years, smoking, low haemoglobin level, and low white blood cell count were independently associated with adverse surgical outcomes. Conclusion Adhesive bowel obstruction was associated with substantial 30-day postoperative morbidity. Older age, smoking, anaemia, and low white blood cell count were independent predictors of adverse surgical outcomes. Early risk stratification, perioperative optimization, infection prevention, and close postoperative monitoring may improve outcomes in regional referral hospital settings.