Abstract:

Background: Secondary peritonitis is one of the most common surgical emergencies with significant morbidity and mortality. Multiple scoring systems have been proposed and assessed in predicting the outcome in patients with peritonitis. Among them is the Mannheim peritonitis index (MPI). MPI is a simple and specific scoring system for predicting outcome in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management. The aim of this study is to assess the usefulness of MPI in predicting outcome among patients with secondary peritonitis at Bugando Medical Centre (BMC).

Methods: This was a cross sectional study involving patients with secondary peritonitis admitted to BMC over a six-month duration between December 2021 and May 2022. The study included all patients who were operated for secondary peritonitis within the period of study.

Results: A total of 88 patients (M: F ratio = 1: 1.7) were studied. Their median age at presentation was 31 [inter-quartile range, 23 - 40.5] years. Ileojejunal perforation was the most common cause of secondary peritonitis in 31(35.2%) patients. Postoperative complication rate was 75.0% and surgical site infection was the most frequent complication in 42.4% of cases. Diffuse generalized peritonitis (p = 0.004) and surgery performed by junior doctors (p= 0.017) were statistically significantly associated with postoperative complications. The overall median length of hospital stay (LOS) was 8 days. Female gender (p = 0.014) and surgery been done by junior doctors (p = 0.005) were the main predictors of LOS. Mortality rate was 13.6% and it was statistically significantly associated with organ failure (p < 0.001) and diffuse type of peritonitis (p = 0.003). MPI scores was significantly associated with mortality (p < 0.001) and postoperative complications (p = 0.013) among patients with secondary peritonitis. MPI <21 were 9(36.0%), 21- 29 were 8(32.0%) and >29 were 8(32.0%). There was no significant association between MPI scores and the length of hospital stay (p =0.389).

Conclusion: This study has demonstrated that MPI scoring is a reliable predictor of mortality and postoperative complications in patients with secondary peritonitis and can be helpful in planning and evaluating future treatments with great ease. We would like to recommend its use in the prognostic evaluation of secondary peritonitis patients at BMC.