Early Operative Risk Assessment Using the Modified Mannheim Peritonitis Index in Patients With Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria.

Abstract

Introduction The use of validated prognostic scoring tools in resource-poor environments has been hampered by the cost of procuring and maintaining devices, such as arterial blood gas analysers, to measure critical physiological derangements.Attempts need to be made to adapt these applicable risk stratification tools so they can be easily adopted in developing countries like Nigeria. Aim This study assessed the usefulness of a modified Mannheim peritonitis index (mMPI) as arisk stratification tool in predicting surgical outcomes in managing patients with generalised peritonitis in Abuja, Nigeria. Methods This was a prospective study of consecutive adult patients managed for generalised peritonitis at a tertiary hospital in Abuja over 12 months. Approval numbers NHA/EC/037/2019 and AF/013/17/110/1514 were ascribed to the project by the Institute Review Board Committee (IBR) of the National Hospital Abuja (NHA) and the National Postgraduate Medical College of Nigeria. The MPI was modified using respiratory rate and suboptimal percentage oxygen saturation (SpO2). Patient characteristics and treatment outcomes obtained were entered into a structured proforma, checked, and analysed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). The threshold score of the modified MPI and the accuracy, sensitivity, and specificity were derived from the receiver operating characteristic (ROC) curve analysis and its coordinates. The level of statistical significance was set at a p-value of <0.05. Results There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (n=15, 30.6%), followed by complicated appendicitis (n=12, 24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predicts mortality at a threshold score point of ≥26 (accuracy of 79.4%, sensitivity of 85.7%, specificity of 61.9%, p=0.013) and morbidity at a threshold score of ≥23 (accuracy of 78.4%, sensitivity of 77.4%, specificity of 72.2%, p=0.001). Conclusion The modified MPI can be used as a risk assessment tool to predict postoperative outcomes in adult patients operated on for generalised peritonitis within 30 days of operative intervention at Abuja.This modification may be helpful in low-resource centres with limited access to arterial blood gas analysers. However, the original MPI might be a more accurate tool.