title: Fatal pulmonary embolism after arthroscopic rotator cuff repair: a case series.
abstract: BACKGROUND
  pulmonary embolism (PE) is a rare and serious complication of arthroscopic orthopaedic surgery. Currently there is great paucity in the literature regarding PE events following arthroscopic rotator cuff (ARCR) surgery. The purpose of this case series was to (1) report our known incidence rate of symptomatic PE following ARCR for a single surgeon and (2) describe five cases of pulmonary embolism following ARCR, detailing patient medical history and potential perioperative risk factors.
  
  
  METHODS
  the number of PE events were queried retrospectively from the institutional database with the ICD-9 code 415.1 within a 10 year time frame (2003-2013). Cases of PE identified by ICD-9 query were reviewed for type of procedure, postoperative day of event, and surgeon. Only patients with a confirmed diagnosis by computed tomography (CT) scan or post-mortem exam, were included in this study. Patient medical records belonging to affected patients were ordered and reviewed by a single investigator. Pre, intra, and postoperative information was obtained and summarized.
  
  
  RESULTS
  5 cases of PE were identified, two of which were fatal. All events occurred in the perioperative period following ARCR. The 10 year incidence rate for PE following ARCR was 0.89%. Medical record review revealed significant risk factors for these patients when compared to current VTE prophylactic guidelines.
  
  
  CONCLUSIONS
  our ten year incidence rate of PE following arthroscopic shoulder surgery and ARCR was 0.25 and 0.89% respectively. These rates were found to be considerably higher than reported rates of PE in the general population and following arthroscopic shoulder surgery. In addition, our methods failed to detect subclinical PE events, resulting in the likelihood of this value to be an underestimate of the true incidence. Medical record review revealed risk factors which would qualify patients for chemoprophylaxis under certain guidelines, however, the validity of available risk stratification methods continue to be a topic of debate.
  
  
  METHODS
  Level IV; case series.
authors.affiliation: The UCONN Health Center, New England Musculoskeletal Institute and Augustus D. Mazzocca receive research support from Arthrex Inc. Naples, FL.
authors.forename: Thomas J S
authors.initials: TJ
authors.lastname: Durant
authors.affiliation: The UCONN Health Center, New England Musculoskeletal Institute and Augustus D. Mazzocca receive research support from Arthrex Inc. Naples, FL.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cote
authors.affiliation: The UCONN Health Center, New England Musculoskeletal Institute and Augustus D. Mazzocca receive research support from Arthrex Inc. Naples, FL.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Arciero
authors.affiliation: The UCONN Health Center, New England Musculoskeletal Institute and Augustus D. Mazzocca receive research support from Arthrex Inc. Naples, FL.
authors.forename: Augustus D
authors.initials: AD
authors.lastname: Mazzocca
keywords: arthroscopy; pulmonary embolism; rotator cuff repair; shoulder