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We appreciate the comments by Dr Hajj-Chahine and associates [1Hajj-Chahine J. Jayle C. Tomasi J. Houmaida H. Corbi P. Same admission cardiac catheterization-cardiac surgery: increased incidence of acute kidney injury and mediastinitis (letter).Ann Thorac Surg. 2011; 92: 776Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] regarding our recent article, “Same Admission Cardiac Catheterization and Cardiac Surgery: Is There an Increased Incidence of Acute Kidney Injury?” [2Kramer R.S. Quinn R.D. Groom R.C. et al.Same admission cardiac catheterization and cardiac surgery: is there an increased incidence of acute kidney injury?.Ann Thorac Surg. 2010; 90: 1418-1423Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar]. Dr Hajj-Chahine and associates [1Hajj-Chahine J. Jayle C. Tomasi J. Houmaida H. Corbi P. Same admission cardiac catheterization-cardiac surgery: increased incidence of acute kidney injury and mediastinitis (letter).Ann Thorac Surg. 2011; 92: 776Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] indicate they have reported an experience similar to ours regarding sternal wound infections. By separating the hospitalizations for heart catheterization and surgery, they have noted a decrease in the incidence of poststernotomy mediastinitis. There are many factors that increase the potential for acute kidney injury (AKI) during the cardiac catheterization admission that can be mitigated by the passage of time. Rosner and Okusa [3Rosner M.H. Okusa M.D. Acute kidney injury associated with cardiac surgery.Clin J Am Soc Nephrol. 2006; 1: 19-32Crossref PubMed Scopus (799) Google Scholar] have described that when these factors are superimposed on dye nephropathy and other aspects of the patients' context during admission, there is a greater chance that the patient will suffer from AKI. If we postulate that AKI is a surrogate for the dysfunction of other organs, the immune system may be compromised during this first admission. Blood and glucose management may not be optimal, further increasing the potential for wound infection. Preoperative anemia drives transfusions, which are associated with increased surgical wound infections [4Bernard A.C. Davenport D.L. Chang P.K. Vaughan T.B. Zwischenberger J.B. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients.J Am Coll Surg. 2009; 208: 931-937Abstract Full Text Full Text PDF PubMed Scopus (364) Google Scholar], and elevated preoperative blood glucose is a risk factor for sternal wound infection [5Trick W.E. Scheckler W.E. Tokars J.I. et al.Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting.J Thorac Cardiovasc Surg. 2000; 119: 108-114Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar]. The experience of Dr Hajj-Chahine and associates [1Hajj-Chahine J. Jayle C. Tomasi J. Houmaida H. Corbi P. Same admission cardiac catheterization-cardiac surgery: increased incidence of acute kidney injury and mediastinitis (letter).Ann Thorac Surg. 2011; 92: 776Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] adds to the list of preoperative risk factors for sternal wound infections. Lu and coworkers [6Lu J.C.Y. Grayson A.D. Jha P. Arun K. Srinivasan A.K. Fabri B.M. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery.Eur J Cardiothorac Surg. 2003; 23: 943-949Crossref PubMed Scopus (208) Google Scholar] found that the preoperative independent risk factors for sternal wound infection included obesity, New York Heart Association functional class ≥ 3, and diabetes. Similarly, Trick and associates [5Trick W.E. Scheckler W.E. Tokars J.I. et al.Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting.J Thorac Cardiovasc Surg. 2000; 119: 108-114Abstract Full Text Full Text PDF PubMed Scopus (149) Google Scholar] have reported modifiable preoperative risk factors, including antibiotic timing and elevated blood glucose levels to reduce the risk of sternal wound infection. The rush to the operating room after cardiac catheterization has appeal in regard to convenience for patients, families, cardiologists, and surgeons. The opportunity to modify risk factors for AKI and sternal wound infection must be considered, which outweighs the convenience of an operation scheduled expeditiously, avoiding adverse events with their associated morbidity, mortality, and increased cost. Same Admission Cardiac Catheterization-Cardiac Surgery: Increased Incidence of Acute Kidney Injury and MediastinitisThe Annals of Thoracic SurgeryVol. 92Issue 2PreviewWe read with great interest the article by Kramer and colleagues [1]. They showed that the incidence of acute kidney injury decreased significantly from 50.2% to 33.7% if the cardiac surgery was undertaken in a subsequent hospitalization after the cardiac catheterization. Therefore, they advocated for separate admissions in nonemergent cases, thus allowing resolution of some of risk factors of postoperative acute kidney injury after cardiac surgery and ultimately reducing overall morbidity and mortality in this patient population. Full-Text PDF