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 : 14.5%, Accuracy: 87.2%; Model 2B Nagelkerke R : 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.