[Fulminant air embolism in arthroscopy of the shoulder joint using CO2]

Study of the evolution and variability of nontraumatic orthopedic surgeries in Brazil-9 years of follow-up: A database study

In Brazil, there are no epidemiological statistics that map nontraumatic orthopedic injuries, their rate of variability, distribution by specialty, fatality rate, and the economic impact that these lesions and their consequences can bring to the country. The objective of this study was to evaluate the rates of variability for skills, deaths, mortality, and the economic impact of nontraumatic orthopedic surgeries in Brazil from 2008 to 2016.This is a descriptive study conducted through the analysis of data relating to the indicators of hospital production regarding orthopedic procedures of the Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de saúde-DATASUS) between 2008 and 2016. The level of significance was 5%.There was a predominance of hospitalizations for surgery of the lower limbs, which also resulted in the largest number of deaths. The surgical mortality rate recorded for the hip also needs to be considered. In general, there is a national increase in the number of orthopedic surgeries performed, accompanied by a concomitant increase in the number of deaths and mortality of the population exposed.We observed a growing demand for hospitalization with a consequent increase in lethality and deaths. We can conclude that between 2008 and 2016, the number of hospitalizations for elective nontraumatic orthopedic surgical procedures increased significantly, driven mainly by lower limb surgeries, along with the cost of the Unified Health System (Sistema Único de Saúde-SUS) for these surgeries.

Chest wall swelling and pneumothorax after shoulder arthroscopy: Were the 2 events totally independent?

RATIONALE

Arthroscopic shoulder surgery (ASS) is a low mortality and morbidity procedure, but anesthetic complications are reported. There have been no reports of combined chest wall swelling and pneumothorax after ASS.

PATIENT CONCERNS

The patient's right lung was severely collapsed and the mediastinum was deviated after ASS.

DIAGNOSIS

Pneumothorax on right chest.

INTERVENTIONS

A chest tube was inserted and oxygen therapy was performed.

OUTCOMES

The patient was discharged uneventfully.

LESSONS

Elective ASS has low mortality and morbidity rates, but we should be more concerned over the complications after ASS.

Complications of arthroscopic shoulder surgery

Shoulder arthroscopic procedures have become common in today's orthopedic practice. The safety of shoulder arthroscopy though well established, is not without complications both minor and significant. The true incidence of complications is difficult to identify in the current literature. However, as with all procedures, complications associated with shoulder arthroscopy do occur. General complications (ie, infection), those specific to shoulder arthroscopy (ie, positioning) and those associated with specific procedures (ie, failure) all have been recognized. The purpose of this article is to review the current literature regarding complications in shoulder arthroscopy, provide insight into the risk factors and types of complications and to provide guidelines on the prevention and management of complications if and when they occur.

Implantation of matrix-induced autologous chondrocyte (MACI ®) grafts using carbon dioxide insufflation arthroscopy

PURPOSE

The purpose of this study was to determine the safety of a new arthroscopic Matrix-induced autologous chondrocyte implant (MACI) technique with carbon dioxide insufflation utilized to improve visualization during the dry phase of the scaffold implant.

METHODS

Between 2004 and 2007, thirty patients were treated for symptomatic focal chondral lesions of the medial femoral condyle. All patients were monitored during surgery for gas embolism signs and symptoms and were evaluated preoperatively and at a median follow-up of 70.5 months (range 48-93 months) using the KOOS subjective evaluation score, the Lysholm function score, the Tegner activity scale for the knee, and the IKDC objective score.

RESULTS

No cases of intraoperative or postoperative symptoms or signs related to gas embolism or persistent subcutaneous emphysema were registered. Each subscale of the KOOS subjective score improved from preoperative to follow-up. The median Lysholm score was 50 (range 15-66) at baseline and 87.5 (range 54-100) at follow-up (p < 0.05). The median Tegner score was 2 (range 1-4) at baseline to 5 (range 2-7) at follow-up (p < 0.05).

CONCLUSIONS

No complications registered, and the satisfactory clinical results achieved in this series suggest that carbon dioxide insufflation during arthroscopic MACI is a safe and accessible option to improve visualization during the dry phase of the scaffold implant on medial femoral condyles.

30-day morbidity and mortality after elective shoulder arthroscopy: a review of 9410 cases

BACKGROUND

Few studies have reported incidence of or risk factors for morbidity and mortality after elective shoulder arthroscopy.

METHODS

We used Current Procedural Terminology (CPT) billing codes to query the National Surgical Quality Improvement Program database and identified 9410 cases of elective shoulder arthroscopy. Univariate and multivariate analyses were used to identify risk factors for complication.

RESULTS

Among 9410 patients, 109 complications occurred in 93 (0.99%). Major morbidity was 0.54% (51 patients), which included 4 patients (0.04%) with a mortality, and minor morbidity was 0.44% (42 patients). The most common complication was a return to the operating room (29 cases, 0.31%). Superficial surgical site infections occurred in 15 cases (0.16%), deep infections in 1 (0.01%), deep venous thrombosis or thrombophlebitis in 8 (0.09%), peripheral nerve injury in 1 (0.01%), and pulmonary embolism in 6 (0.06%). The multivariate analysis showed smoking history (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.12-3.27), history of chronic obstructive pulmonary disease (OR, 3.25; 94% CI, 1.38-7.66), operative time of longer than 1.5 hours (OR, 2.1; 95% CI, 1.32-3.36), and American Society of Anesthesia class of 3 or 4 compared with 1 or 2 (OR, 1.82; 95% CI, 1.03-3.21) as risk factors for complication.

CONCLUSIONS

Morbidity and mortality are rare events after elective shoulder arthroscopy, and the procedure should generally be considered safe. Surgeons should offer smoking cessation to active users of tobacco and should be efficient with operative time whenever possible.

LEVEL OF EVIDENCE

Level II, prospective cohort design, treatment study.

Complications associated with arthroscopic shoulder surgery

We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two decades. As with all interventions complications can occur which require recognition and management by the orthopedic surgeon. While the literature is helpful with identifying types of complications, establishing the rate of these complications remains elusive. These complications can be divided into general complications, complications generic to all shoulder procedures, and complications specific to the type of procedure performed. General complications such as infection and anesthesia problems continue to show low incidences. Shoulder arthroscopy presents increased risk of complications over knee arthroscopy in regard to vascular and neurologic injury, fluid extravasation, stiffness, iatrogenic tendon injury, and equipment failure. New techniques of increased complexity for subacromial surgery, rotator cuff repair, and arthroscopic instability present new problems related to implant failure, nerve injury, iatrogenic fracture, and capsular necrosis. While the rate of complications especially with newer procedures remain elusive, most studies suggest that the rate is low, 5.8-9.5% in all recent review studies published. Underreporting complications makes assessment of incidence rates of complication difficult. Proper patient selection, attention to operative detail, and careful post-operative monitoring can minimize the morbidity associated with these complications.

An unexpected death during oxygen-ozone therapy

An unexpected death is described that was caused by gas embolism that occurred during oxygen-ozone (O2/O3) therapy administered by autohemotransfusion for psoriasis. This unusual complication suggests the necessity of investigating benefits and adverse effects of medical ozone application.