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The Comorbidity-Polypharmacy Score is an Objective and Practical Predictor of Outcomes and Mortality after Vascular
Linh Ngo Khanh1, Irene B Helenowski1, Andrew W Hoel1
1Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
The Comorbidity-Polypharmacy Score (CPPS) effectively predicts mortality and adverse outcomes in vascular surgery patients. Higher scores indicate increased risk, aiding in clinical decision-making and resource allocation.
Area of Science:
- Vascular Surgery
- Geriatric Trauma
- Clinical Risk Assessment
Background:
- The Comorbidity-Polypharmacy Score (CPPS) quantifies comorbidity and medication burden.
- CPPS was initially developed for geriatric trauma patients.
- Its adaptability to other clinical settings, like vascular surgery, was explored.
Purpose of the Study:
- To investigate the association between CPPS and patient outcomes after common vascular surgery.
- To determine if CPPS predicts mortality in patients undergoing vascular procedures.
Main Methods:
- Retrospective single-center study of 466 patients undergoing carotid endarterectomy, infrainguinal bypass, lower extremity revascularization, or endovascular AAA repair.
- Patients categorized into mild, moderate, severe, and morbid CPPS groups.
- Statistical analyses included chi-squared, Kruskal-Wallis, Kaplan-Meier, Cox proportional hazard models, and ROC analyses.
Main Results:
- Higher CPPS correlated with longer hospital and postoperative stays.
- Severe/morbid CPPS associated with increased ICU admission, reintervention, and 30-day readmission rates (not statistically significant post-correction).
- CPPS independently predicted 1- and 5-year mortality (HR=2.2) with high accuracy (C-statistics 0.81 and 0.72).
Conclusions:
- CPPS is a practical tool for assessing risk of adverse outcomes and mortality in vascular surgery.
- Further validation is needed to integrate CPPS into outcome prediction and clinical planning.
- CPPS may aid in resource allocation and discharge planning for vascular surgery patients.
Background:
The comorbidity-polypharmacy score (CPPS) was developed to quantify the severity of comorbidities of patients with geriatric trauma. CPPS is the sum of the number of medications and comorbidities, and is thus objective, user-friendly, and potentially adaptable to many clinical situations. We sought to understand if CPPS associates with outcomes and mortality after common vascular surgery procedures.
Methods:
This is a retrospective single-center study. A total of 466 patients who underwent carotid endarterectomy, infrainguinal bypass, percutaneous lower extremity revascularization, or endovascular abdominal aortic aneurysm repair at a single medical center were included. CPPS were classified as mild, moderate, severe, and morbid based on scores of 0-7, 8-15, 15-21, and ≥21, respectively. End points were reinterventions, 30-day readmission, and mortality. We used chi-squared tests to analyze differences in categorical variables; Kruskal-Wallis tests to analyze differences in continuous variables; Kaplan-Meier estimation and Cox proportional hazard modeling to examine survival data; and receiver operator characteristic (ROC) curve analyses to assess sensitivity and specificity.
Results:
The mean preoperative CPPS was 14.1 ± 6.1. Higher CPPS were associated with longer hospital and postoperative length of stay (P < 0.001). Severe and morbid CPPS categories had higher rates of ICU admission, reintervention, and 30-day readmission which did not reach statistical significance after correction for multiple comparisons. CPPS was independently associated with 1- and 5-year mortality in a multivariable Cox model (hazard ratio = 2.2, 95% confidence interval: 1.3-3.3). ROC analysis revealed C-statistics of 0.81 and 0.72 for 1-year and 5-year all-cause mortality, respectively (P < 0.001).
Conclusions:
CPPS is a simple and pragmatic clinical tool for quantifying risk of postoperative outcomes and mortality after common vascular surgery procedures. Further investigation is needed to validate the use of CPPS in enhancing existing predictors of patient outcomes and in serving as an adjunctive tool for determining resource allocation and discharge planning in patients who underwent vascular surgery.
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