3 Results:
This study included the data of 297 diabetic patients who underwent
isolated coronary bypass surgery. Since our study focuses entirely on
postoperative bleeding, patients who died due to any other reason within
the first 24 postoperative hours were excluded from the study, along
with patients who were re-explored for any reason other than bleeding.
We based our study on the E-CABG study and evaluated the bleeding
prediction scores accordingly. In addition, we examined the average
drainage amount of the patients and analyzed the data.
The patients were divided into two groups according to their E-CABG
grades (Table 2). E-CABG Grades 0 and 1 (n = 260) were evaluated in the
same group, just as Grades 2 and 3 (n = 37). Grade 2-3 patients had
lower BMI (p <0.001), and higher drainage amounts in first 24
hours postoperatively (p<0.001), higher postoperative
creatinine values (p = 0.02), higher amounts of postoperative blood
product transfusion (RBC transfusion (p <0.001), FFP
transfusion (p <0.001) and platelet transfusion (p
<0.001)), and a higher ratio of female patients (p = 0.006).
Patients were grouped according to the amount of drainage from thoracic
tubes and re-evaluated (Table 3). The median drainage was 600 ml (450ml
and 850ml for 25% and 75% percentiles, respectively). A cut-off value
of 850 ml (75% percentile) indicated massive drainage in our study
group, and when grouped accordingly, preoperative platelet count (p
<0.001), creatinine clearance (p = 0.025), eGFR (p = 0.004)
and BMI (p <0.001) values were significantly higher among
patients with drainages of less than 850 ml/day. Postoperative
creatinine values (p = 0.008) and female gender (p = 0.001) were
higher in patients with a drainage of more than 850 ml/day.
Significant variables in univariate analysis or those confirmed as
significant in clinical practice were carried onto multivariate analysis
(Table 4). Risk factors for E-CABG II-III scores were analyzed in Models
1A and 2A, and risk factors for massive postoperative drainage were
analyzed in Models 1B and 2B (Model 2A: Nagelkerke
R 2 : 14.5%, Accuracy: 87.2%; Model 2B Nagelkerke
R 2 : 15.1%, Accuracy: 74.4%). Accordingly, female
gender (p = 0.01) and BMI (p <0.001) were significant in
E-CABG Group 2-3. In the multivariate analysis performed according to
the amount of drainage, female gender (p = 0.015), preoperative platelet
values (p = 0.037) and BMI (p <0.001) were significant.
Examinations of risk scores (Table 5) determined that ’PAPWORTH’ was
significant for E-CABG Group 2-3 (p = 0.03). In our study, other scoring
systems were not significant in predicting postoperative
bleeding. However, all bleeding risk scores were insignificant in terms
of drainage amount. Among the scoring parameters, preoperative hemogram
(or hematocrit) value, platelet count, creatine (or eGFR), female
gender, and antiplatelet use could be included into ORS.