Objective To develop a predictor of early surgical intervention in patients with adhesive small-bowel obstruction (ASBO), to optimise treatment strategies and improve patient outcomes. Methods A retrospective analysis was conducted of patients with ASBO between August 2019 and June 2024. Clinical, laboratory and imaging data were analysed. A scoring system was developed using C-reactive protein (CRP) concentration, white blood cell (WBC) count, body mass index (BMI), and imaging findings. Results The developed ASBO surgical score predicted the need for early surgery with a sensitivity of 89.6%, a specificity of 87.3%, and an area under the curve of 0.88. Patients with a score of 5 to 7 were significantly more likely to require surgical management: 75% of these patients underwent surgery, versus 4.2% in the Conservative treatment group. Key predictors of the need for surgery were high CRP concentration (>54.3 nmol/L), high WBC count (>11.0 x 10(9)/L), BMI <22 kg/m(2), maximum small intestinal diameter on computed tomography images >3.85 cm, and free fluid in the abdominal cavity. Conclusions The ASBO surgical score is a practical tool that should aid in the timely identification of patients requiring surgical intervention, and may reduce the risk of complications and improve the outcomes of patients.