title: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Columbia University School of Nursing, 630 West 168th St., New York, NY 10032, USA. lba2126@columbia.edu
authors.forename: Lee Boon
authors.initials: LB
authors.lastname: Ang
authors.forename: Evangeline N
authors.initials: EN
authors.lastname: Veloria
authors.forename: Eileen Y
authors.initials: EY
authors.lastname: Evanina
authors.forename: Arlene
authors.initials: A
authors.lastname: Smaldone
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D017707:Erythrocyte Transfusion / Q000379:methods*; D006801:Humans; D008480:Mediastinitis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology