Mannheim Peritonitis Index as a Predictor of Post-operative Complications, Mortality and Duration of Hospital Stay in Patients with Peritonitis due to Hollow Viscus Perforation: A Prospective Cohort Study

Abstract

Introduction: Peritonitis due to hollow viscus perforation is a common surgical emergency and can be life-threatening. Patients who undergo surgery for peritonitis require extensive counselling to fully understand the nature of the disease, the need for surgery, post-operative complications and the duration of hospital stay. Hence, scoring systems are necessary to determine the severity of the disease to provide sufficient prognostic data. Aim: To evaluate the Mannheim Peritonitis Index (MPI) scoring system as a predictor of post-operative complications, mortality and duration of hospital stay in patients with peritonitis due to hollow viscus perforation. M aterials and Methods: The prospective cohort study was carried out in 50 diagnosed cases of perforation peritonitis admitted at the centre during the study period from November 2017 to October 2018. MPI was calculated for each patient, following which they were stratified into three risk groups- 1, 2 and 3 with scores of ≤20, 21-29 and ≥30, respectively. Post-operative complications, mortality, and duration of hospital stay were analysed. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) software 24.0. Results: Out of 50 patients included, 36 were male and 14 were female with a mean age of 41.14 years. A total of eight patients suffered mortality. The incidence of mortality in risk Group-1 was 0 out of 29 patients (0%), risk Group-2 was 3 out of 13 patients (23.1%) and risk Group-3 was 5 out of 8 patients (62.5%), respectively and hence MPI was a useful indicator of prediction of mortality in perforation peritonitis patients. The risk factors which had a higher significance in predicting mortality were found to be, organ failure at presentation and the nature of intra-peritoneal exudate with a p-value of 0.029 and <0.001, respectively. In 29 patients, there were no complications and 13 patients had a single complication, 8 patients had multiple complications. The incidence of multiple post-operative complications in a patient in risk Group-1, 2 and 3 were 1 (12.5%), 2 (25%) and 5 (62.5%) patients, respectively. The number of complications in a patient increased as the MPI score increases. Dispersion of duration of hospital stay in discharged patients according to MPI score using Pearsons’s correlation, showed statistical significance with the value of r being 0.6214, the p-value being 0.000011. The duration of hospital stay of patients who were discharged, increased as the MPI score increased. Conclusion: MPI was effective in predicting post-operative complications, mortality and duration of hospital stay in patients with peritonitis due to hollow viscus perforation and hence can be used as an effective tool to facilitate counseling and educate the patient and relatives regarding the expected course of the disease in that particular patient.

Keywords

• organ failure
• laparotomy
• intra-peritoneal exudate
• scoring system