[The Mannheim Peritonitis Index cannot be routinely used to guide surgical decision-making for peritonitis].

Abstract

Objective: To evaluate the evidence base of the Mannheim Peritonitis Index (MPI) for choice of relaparotomy (programmed vs on-demand) in severe peritonitis.

Material and methods: The study was carried out in 3 stages.

1. MPI-based assessment of evidence base of national guidelines «Peritonitis» regarding the choice of relaparotomy (programmed vs on-demand).

2. Statements and recommendations of current foreign guidelines on MPI-based choice of tactics for peritonitis.

3. Systematic review of evidence base of studies that used MPI to determine surgical tactics.

Results: The studies listed in national guidelines do not provide evidence of feasibility of MPI as a tool for determining tactics. This index is not mentioned in 3 out of 7 foreign recommendations on abdominal surgical infection. In other recommendations with moderate level of recommendations and low level of evidence, MPI is indicated as a tool for predicting mortality. In 7 retrospective studies not included in recommendations, there was no evidence for advisability of MPI to determine surgical tactics.

Conclusion: There is currently no evidence base for MPI in choosing programmed or on-demand relaparotomy in case of severe peritonitis. Further high-evidence studies are required to find significant criteria.