Determinants of Outcome in Intestinal Obstruction: Insights from a Prospective Cohort Analysis at a Tertiary Care Centre in India

Abstract Background Intestinal obstruction (IO) is a frequently encountered surgical emergency necessitating early diagnosis, adequate resuscitation, and timely management to mitigate the risk of severe complications, including bowel ischaemia, perforation, and sepsis, and carries significant morbidity and mortality. Objective To delineate aetiological trends and identify independent clinical, biochemical, and radiological predictors of the need for surgical intervention, bowel resection, postoperative complications, length of hospital stay and mortality in patients with IO. Methods This prospective cohort study was conducted between August 2023 and August 2025 on 74 of the 427 patients with IO admitted to surgical wards during the study period. Data including clinical presentation, laboratory parameters and radiological findings of CECT abdomen were recorded at admission. Outcome measures were analysed using appropriate statistical tests. Logistic regression and ROC analysis identified independent predictors and discriminatory performance; p  p  p  p  = 0.006), bowel resection (AUC = 0.85, OR = 1.01, p  = 0.001), complications (AUC = 0.86, OR = 1.01, p  p  = 0.001). Serum LDH also demonstrated discriminatory ability for mortality (AUC = 0.82), but did not retain independent significance in the multivariable model. Hypoenhancement of the bowel on CECT was strongly associated with bowel resection ( p  = 0.0004), and pneumatosis intestinalis mandated resection in all three affected patients (p = 0.015). Conclusion Shock and fever at presentation are highly significant risk factors for adverse outcomes in patients with IO and therefore warrant prompt evaluation and resuscitation. Serum LDH is a cost-effective, widely available marker that independently predicts major adverse outcomes in IO. CECT features of bowel wall hypoenhancement and pneumatosis intestinalis are critical predictors of bowel resection. Trial Registration: Obtained from the Institutional Ethics Committee, Jawaharlal Nehru Medical College & Hospital, Faculty of Medicine, Aligarh, India, vide Ref. No. IEC/JNMC/1003 dated 28/08/2023, following review at the IEC meeting on 15/07/2023.