What is the clinical evidence from this study?

Study design: Observational. Population: Diabetes mellitus patients undergoing isolated coronary artery bypass grafting (n=297). Intervention: Papworth bleeding risk score vs. Lower scores. Primary outcome: Prediction of severe postoperative bleeding (E-CABG grades 2-3) (HR 1.807, 95% CI 1.057-3.089, p=0.030).

What question did this study set out to answer?

To evaluate the effectiveness of current scoring systems in predicting postoperative bleeding after diabetic coronary artery bypass surgery and identify optimal parameters.

February 5, 20260 citations

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

EAEngin Akgül AÖAbdülkerim Özhan

Key Result

The Papworth score significantly predicted severe postoperative bleeding (E-CABG grades 2-3) in diabetic patients undergoing coronary artery bypass grafting (HR 1.807), whereas other scoring systems did not.

Key Points

To evaluate the effectiveness of current scoring systems in predicting postoperative bleeding after diabetic coronary artery bypass surgery and identify optimal parameters.
Analysis of factors associated with postoperative bleeding
Evaluation of existing scoring systems
Assessment of parameters like gender, body mass index, and platelet count
Female gender and lower body mass index correlate with higher bleeding risk
Preoperative platelet count is significantly linked to increased bleeding
Current scoring systems yield unsatisfactory predictive results

Study Design

Type

Observational (n=297)

Multicenter

Structured PICO

Do existing scoring systems and clinical parameters accurately predict postoperative bleeding in diabetic patients undergoing isolated CABG?

Population

297 diabetic patients undergoing first-time isolated coronary artery bypass grafting, evaluated retrospectively for predictors of early postoperative massive bleeding within 24 hours.

Exposure

Evaluation of preoperative clinical parameters and existing bleeding risk scoring systems (Papworth, WILL-BLEED, ACTA-PORT, TRACK, and TRUST)

Outcome

Postoperative bleeding within the first 24 hours, defined by E-CABG bleeding severity grades 2-3 and massive drainage (> 850 mL/day)safety

Current bleeding risk scores have limited predictive value for postoperative bleeding in diabetic patients undergoing CABG, suggesting a need for a tailored score incorporating gender, BMI, and platelet count.

Main Result

Hazard Ratio: 1.807 (95% CI 1.057–3.089)

p-value: p=0.030

Limitations

Retrospective and single-center design
Lack of separate evaluation for different antiplatelet agents (e.g., clopidogrel vs ASA)
Unknown presence of underlying hematological diseases
Unknown effectiveness of thoracic cavity aspiration before sternal closure
Lack of thromboelastogram before administering blood products

Abstract

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.

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