Abstract:
Background: One of the most undesired complications after open
heart operations is bleeding. In our study, we set ourselves two
different goals: examining ‘Papworth, Will-Bleed, Track and Trust’
bleeding scoring systems to determine the most predictive one among
diabetic patients undergoing isolated coronary bypass surgery, and
determining the variables that should be included in the new scoring
systems to be established for this patient group.
Methods: The files of 297 diabetic patients who underwent
isolated coronary artery bypass operation between 2017-2019 were
retrospectively reviewed. Patients who underwent emergency surgery with
a beating heart, those with reoperated open hart surgery, those with
ticagrelor use, and those who died within the first 24 postoperative
hours were excluded from the study. Drainage from the thorax and
mediastinal tubes and blood product transfusions to the patients within
the first 24 hours were noted and analyzed according to scoring systems.
Results: Scoring systems are evaluated based on ‘European
Multicenter Study on Coronary Artery Bypass Grafting Bleeding Severity
(E-CABG)’. In this study including diabetic patients only, Papworth was
better predictive of E-CABG bleeding Grade 2-3. We found that
Will-Bleed, Track, Trust, the other scoring systems we examined had
discriminatory value in terms of E-CABG bleeding Grade 2-3 in our study
group. Among the parameters in the scoring systems, we concluded that
gender, preoperative hemoglobin (or hematocrit) value, preoperative
platelet count, use of antiplatelets until less than five days prior to
the operation, and preoperative creatinine (or eGFR) values should be
included in the scoring system we aim to establish in the future, called
the “Optimum Risk Score for Bleeding (ORS).”
Conclusion: Considering the possible risks of bleeding and
blood product transfusion, scoring systems that will provide accurate
results for patient blood management will be lifesaving and increase the
cost-effectiveness of the treatment.
Key Words: coronary artery bypass graft, will bleed. track,
trust, E-CABG, papworth, bleeding