Objective To analyze the risk factors associated with surgery in patients with adhesive intestinal obstruction, and to establish a risk prediction model and evaluate its effectiveness. Methods The clinical data of the patient diagnosed as adhesive small bowel obstruction in General Surgery Department of Hunan Provincial People’s Hospital from January 1, 2014 to December 31, 2015 (derivation cohort) and from January 1, 2016 to December 31, 2017 (validation cohort) were retrospectively analyzed. The clinical data of the patients were compared between the non-surgical and surgical groups in derivation cohort. The statistically significant indicators were selected for Logistic regression analysis and the predictive model was established according to the b-factor. The model was used in validation cohort, and the sensitivity and specificity were calculated. Results Univariate analysis indicated that age (P < 0.05) and ascites (P < 0.05) were statistically different between the surgical and non-surgical groups. Logistic regression analysis indicated that the age of ≥ 65 (b =1.6, P < 0.05) and the presence of ascites (b =1.7, P < 0.05) were important indicators. The specificity of the high-risk group was 96% and the sensitivity of the low-risk group was 100%. Conclusions The prediction model performs well for risk stratification of surgical intervention or conservative strategy among ASBO patients.