Stratified Outcome Evaluation of Peritonitis
Background: The heterogeneity of disease severity in peritonitis makes outcome prediction challenging. Risk evaluation in secondary peritonitis can direct treatment planning, predict outcomes and aid in the conduct of surgical audits. Objective: To determine the outcome of peritonitis in patients stratified according to disease severity at the Kenyatta National Hospital (KNH). Design: Prospective descriptive cross sectional survey.
Methods: Seventy patients were consecutively enrolled within 24 hours of operation for peritonitis between December 2007 and April 2008. To stratify patients according to severity, Mannheim Peritonitis Index (MPI) scores were calculated using the following risk variables: age, sex, preoperative duration, organ failure, sepsis source, malignancy, character and extent of exudate. The main outcome on follow up was complications. Secondary outcomes were length of hospital stay and mortality for different MPI scores.
Results: Fifty six males and 14 females (M:F=4:1) were analysed. The mean age was 32.17 years (age range 13-59 years). Forty six (65.7%) had generalised peritonitis, 15(21.4%) had 2-3 quadrant peritonitis while 9(12.9%) had focal peritonitis. Common sources of peritonitis were perforations of appendicitis (31.4%), duodenal ulcer (22.9%) and ileum (18.6%). Patients who complicated had a mean MPI of 26.9 compared to those who did not (22.8) (p=0.018). Morbidity rates increased with rising MPI scores (31% for MPI <21, 54.2% MPI 21-29, 64% MPI >29). The risk of death was double for patients with an MPI ≥26. Hospital stay was 14 days for the whole group but 22 days for those who developed complications. ROC curve analysis showed a predictive power of 0.916 with a sensitivity of 88.9% and specificity of 85.2% at MPI of 29 points.
Conclusion: MPI scores related with outcomes of peritonitis and can be used in prognosticating early outcome in patients with surgical peritonitis at KNH.
Key Words: Peritonitis, Outcome stratification, Mannheim peritonitis index
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