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.