The Role of the Mannheim Peritonitis Index in Predicting Mortality and Morbidity in Perforation Peritonitis Patients in a tertiary care hospital in southern Rajasthan

Background Perforation peritonitis is a critical surgical emergency associated with significant morbidity and mortality. The Mannheim Peritonitis Index (MPI) is a widely recognized prognostic tool for assessing the severity and predicting outcomes in patients with perforation peritonitis. This study aims to evaluate the efficacy of the MPI in predicting mortality and morbidity in patients with perforation peritonitis at a tertiary care hospital in southern Rajasthan, India. Methods This prospective observational study was conducted over 18 months and included 70 patients aged 15–75 years with secondary peritonitis due to hollow viscus perforation. Patients with primary peritonitis, anastomotic leaks, immunocompromised conditions, peritoneal dialysis, abdominal injuries, poly-trauma, or those managed conservatively were excluded. The MPI was calculated post-surgery to classify patients into low, moderate, or high-risk groups. Key outcomes measured included hospital and ICU stay duration, postoperative complications, and overall morbidity and mortality. Statistical analysis was performed using chi-square tests for categorical data and appropriate tests for continuous data, with a p-value < 0.05 considered significant. Results The majority of patients were in the 31–40 years age group (24.3%), with a male predominance (62.9%). Cloudy exudate was the most common finding (51.4%), followed by fecal (20%) and purulent (15.7%) exudates. Generalized peritonitis was observed in 57.1% of patients. Most patients fell into the moderate-risk MPI category (48.6%). Higher MPI scores correlated with increased ICU stay, complication rates, and mortality. Nearly all patients in the severe MPI category required ICU admission (95%), and the highest mortality rate (35.7%) occurred in this group. Fecal exudate was significantly associated with higher mortality (p = 0.033). Conclusion Our study corroborates the extensive body of research on the Mannheim Peritonitis Index, reinforcing its value as a prognostic tool in the management of perforation peritonitis. The consistent findings across various studies underscore the MPI's reliability and utility in clinical practice, providing a robust framework for predicting patient outcomes and guiding treatment strategies. Future research should focus on integrating the MPI with other clinical parameters and validating it in diverse populations to enhance its predictive power and clinical utility.