# Determining the Optimal Parameters for Scoring Systems to Predict Postoperative Bleeding After Diabetic Coronary Artery Bypass Surgery

## TL;DR

This study evaluates existing scoring systems for predicting postoperative bleeding in diabetic patients after heart surgery and identifies key parameters for a new, more accurate system.

## Contribution

The study identifies specific parameters for a new scoring system (ORS) to better predict postoperative bleeding in diabetic patients.

## Key findings

- Current scoring systems like ACTA-PORT and TRACK lack discriminatory value for predicting severe postoperative bleeding.
- Female gender, lower BMI, and preoperative platelet count are associated with increased bleeding risk.
- The proposed ORS will include parameters like preoperative hemoglobin and creatinine levels.

## Abstract

Postoperative bleeding increases morbidity and mortality. We aimed to review
the scoring systems used to predict massive bleeding after isolated coronary
artery bypass grafting in diabetic patients and determine the parameters of
the new scoring system - the Optimum Risk Score for Bleeding (ORS).

Two hundred ninety-seven diabetic patients who underwent isolated coronary
artery bypass operation between 2017 and 2019 were reviewed. The patients
were grouped according to amount of drainage (> 850 mL/day) and the
European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG)
bleeding severity grade. Previously identified risk factors and scoring
systems (Papworth, WILL-BLEED, Association of Cardiothoracic Anesthetists
perioperative risk of blood transfusion [ACTA-PORT], Transfusion Risk and
Clinical Knowledge [TRACK], and Transfusion Risk Understanding Scoring Tool
[TRUST]) were analyzed.

Papworth was better predictive for E-CABG bleeding grades 2 - 3. WILL-BLEED,
ACTA-PORT, TRACK, and TRUST had no discriminatory value in terms of E-CABG
bleeding grades 2 - 3. Among the parameters in the scoring systems, 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 estimated glomerular filtration rate) values
should be included in the scoring system we aim to establish in the future,
the ORS.

The current scoring systems do not provide satisfactory results in predicting
postoperative bleeding. Female gender, lower body mass index, and
preoperative platelet count were associated with increased postoperative
bleeding. There is a need for an ORS which gives more precise results in
predicting postoperative bleeding.