Mediastinitis and blood transfusion in cardiac surgery: A systematic review

Abstract Background Mediastinitis, a serious complication after cardiac surgery, increases morbidity, mortality, and cost of care. Accumulating evidence implicates blood transfusions in the development of mediastinitis. Objectives We conducted a systematic review to evaluate the association between...

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Bibliographic Details
Published in:Heart & lung 2012-05, Vol.41 (3), p.255-263
Main Authors: Ang, Lee Boon, MS, ACNP, Veloria, Evangeline N., MS, ACNP, Evanina, Eileen Y., MS, CRNA, Smaldone, Arlene, DNSc, CPNP-BC, CDE
Format: Article
Language:English
Subjects:
Allogeneic transfusion
Blood transfusions
Cardiac surgery
Cardiac Surgical Procedures - adverse effects
Cardiac Surgical Procedures - methods
Cardiovascular
Cost
Critical Care
Erythrocyte Transfusion - methods
Heart surgery
Humans
Inflammatory diseases
Mediastinitis
Mediastinitis - epidemiology
Mediastinitis - etiology
Pulmonary/Respiratory
Risk Factors
Surgical outcomes
Systematic review
Transplantation, Homologous
United States - epidemiology
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Summary:Abstract Background Mediastinitis, a serious complication after cardiac surgery, increases morbidity, mortality, and cost of care. Accumulating evidence implicates blood transfusions in the development of mediastinitis. Objectives We conducted a systematic review to evaluate the association between allogeneic blood transfusion and mediastinitis in adult cardiac surgery patients. Results After a search of Medline, PubMed, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and the Institute for Scientific Information's Web of Knowledge (1990-2010) for relevant studies, 7 (3 prospective cohort and 4 retrospective reviews) met our inclusion/exclusion criteria. Between 20% and 80.2% of patients received blood transfusions, with an incidence of mediastinitis ranging from 0.1% to 2.3%. Five studies demonstrated an independent association between red blood cell transfusion and mediastinitis. Two studies identified a dose-response relationship. Conclusion The findings of this systematic review suggest that allogeneic red blood cell transfusions are associated with an increased risk of mediastinitis in patients undergoing cardiac surgery. Individual risks and benefits should be assessed in each patient before a red blood cell transfusion.
ISSN:0147-9563
1527-3288
DOI:10.1016/j.hrtlng.2011.07.012