Prognostic Peritonitis Model (PPM) of Ohmann et al Following Surgical Diagnosis of Peritonitis

 

Exclusions:

(1) primary (spontaneous) peritonitis

(2) peritonitis secondary to pancreatitis

(3) surgery within 8 hours of abdominal trauma

 

Parameters:

(1) acute physiology score (APS) from APACHE II (see Section 30.02.01, score range 0 to 60) prior to surgery

(2) number of concurrent (comorbid) conditions

(3) Gorlis score for multiple organ failure on the first post-operative day (see Section 30.06, score range 0-14 for 7 organ systems)

(4) age

(5) ability of surgery to correct the cause of the peritonitis (successful)

 

Concurrent conditions:

(1) liver disease

(2) cerebrovascular disease

(3) respiratory disease

(4) renal disease

(5) immunodeficiency

(6) gastrointestinal disease

(7) malignancy

(8) diabetes mellitus

 

where:

• The first post-operative day can be interpreted as the 24 hours after wound closure to the day starting at midnight on the day after surgery (with day of surgery taken as day 0).

• I did not see cardiovascular disease listed as a concurrent condition. I will assume that it is included under cerebrovascular disease. I would also think malnutrition would be a significant condition.

Parameter	Finding	Points
preoperative APS (from Apache II)		(APS)
age in years		(age) / 2
number of concurrent diseases	from 0 to 8	(number of concurrent diseases) * 5
Goris score		3 * (Goris score)
surgical correction of cause	resolved	0
	unresolved	25

 

total score =

= SUM(points for all of the parameters)

 

Interpretation:

• minimum total score: 0

• maximum total score: 217

• A total score >= 55 indicates at patient at high risk for complications (anastomotic leak, abscess, fistula, pneumonia, sepsis, surgical site infection, death).

 

Total Score	Mortality Rate
< 30	0
30 - 49.9	6%
50 - 59.9	15%
60 - 69.9	40%
70 - 79.9	58%
>= 80	76%

from Figure 5, page 58