1 Introduction
In the light of the studies in the literature, we now know that postoperative bleeding is a serious cause of mortality and morbidity that disrupts the function and structural integrity of organs1,2 Bleeding can occur due to many different surgical procedures. However, the fact that atherosclerotic patients receive antiplatelet treatment is significant for cardiac surgeons, whose working area consists of blood and the circulatory system3. Conditions such as hemodilution, number and structural changes in platelets, and hypothermia which occur during cardiac operations performed with a heart-lung machine may also cause impairment of the coagulation system4. The need for blood transfusion in cardiac operations varies between 20% and 80% 5. This wide transfusion margin is because post-operative hemorrhagic drainage is considered normal for a certain period and amount unless the patient is hemodynamically unstable1,3. While drains that do not disrupt hemodynamics do not require re-exploration, bleeding that causes hypovolemia can lead to permanent damage to vital organs and life-threatening consequences 6. As it requires more fluid replacement, postoperative volume loss increases the need for transfusion and related complication rates. In addition, postoperative bleeding has also been shown to increase ICU stay, infection rate, intubation time and hospital costs 7,8.
Postoperative bleeding may occur due to coagulopathy, or surgical technique and related problems. Whatever the reason, guidelines on blood management have been established 9 based on numerous studies performed on coronary bypass operations over the years. For successful postoperative bleeding control, the process needs to begin from the preoperative period 5. A thorough analysis of preoperative demographic data and drug use will help the postoperative process to proceed more smoothly. Detection of anemia, initiation of erythropoietin therapy and practices to increase preoperative blood reserve, such as blood donation, may help reduce the need for postoperative transfusion5. The need for transfusion can be significantly reduced with perioperative cell salvage methods10.
Less postoperative drainage results in the use of less blood product transfusions. Thus, complications related to blood product transfusion are also reduced. It is for this reason that scoring systems have been defined for the bleeding modality. The ones we investigate in this study, i.e., PAPWORTH, was developed by Vuylsteke et al 11, WILL-BLEED, by Biancari et al. 3, ACTA-PORT, by Klein et al 12, TRACK, by Ranucci et al 13, and TRUST was developed by Alghamdi et al 14.
For this retrospective study, the need to obtain informed consent was exempted. Our aim in this study was to review the scoring systems that can be used to predict early massive bleeding after CABG in diabetic patients undergoing isolated coronary bypass surgery and determine the parameters of the ORS, which is currently an ongoing project. The reason we chose this patient population is because diabetes causes microvascular endothelial dysfunction 15,16 and impairments have been shown in the fibrinolytic system and coagulation factor functions in diabetic patients 17. Endothelial damage, increased oxidative stress, chronic inflammation and impaired fibrinolytic system seen in patients with DM are its main causes17. Surgical technique-induced bleeding such as anastomotic leak, and non-ligatured vascular structures were found in the operation notes and these patients were excluded from our study.