Prediction of mortality and morbidity in patients with secondary peritonitis using POMPP scoring

Abstract

Introduction "POMPP [Practical scoring system of mortality in patients with perforated peptic ulcer] is a simple, clinically applicable scoring system that may allow surgeons to rapidly predict mortality rates in patients based on objective data." This study was aimed at using the POMPP scoring in secondary peritonitis patients for rapid assessment, to predict the mortality and morbidity and to validate POMPP scoring. Methodology This observational study was conducted on patients with suspected secondary peritonitis at the Himalayan Institute of Medical Sciences, Dehradun over a period of 12 months from January 2017 to December 2017. All patients fulfilling inclusion criteria were included with written informed consent. The parameters under evaluation for each patient under the POMPP scoring were Age [> 65 years], serum albumin [< 1.5gm/dl] and blood urea nitrogen [> 45 mg/dl], with each parameter having a score of 1. Risk of mortality and complications associated with POMPP score were analysed using statistical tests including chi square test, student t test and Fisher exact test. A p value < 0.05 was considered statistically significant. Results During the study period a total of 138 patients undergoing laparotomy for peritonitis were enrolled and evaluated. There were 86 [62.3%], 42 [30.4%], 9 [6.5%] and 1 [0.7%] patients with scores of 0, 1, 2 and 3, respectively. Additionally, the postoperative complications were broadly divided into local, respiratory, renal, cardiovascular, systemic and anastomotic complications. Local Complications were found to be most common with 38 [27.5%] patients. Study of mortality associated with each score revealed there was 3.5% mortality with score 0, 16.7% with score 1, 44.4% with score 2, 100% with score 3 thus indicating that the gravest prognosis lies with patients who present with a POMPP score of 3. However, there was only one patient who had POMPP score 3. This observation of increasing POMPP score with relation to mortality was deemed statistically significant [p<0.05] using Fisher's exact test. Conclusions Gastrointestinal perforation and secondary peritonitis patients have been shown to have a strong association with advanced age, blood urea nitrogen and serum albumin levels. Analysis of these simple clinical and biochemical parameters in our study has helped in validation of the POMPP scoring system for risk stratification of cases of secondary peritonitis. It has been observed to be a simple, clinically applicable scoring system that may allow surgeons to rapidly predict morbidity and mortality rates in all types of gastrointestinal perforations.