Dear Editor,

We read the recent case report by Yang and Zu with a great interest [1]. In this report, the case of acute pulmonary embolism after inguinal hernia repair is reported [1]. Yang and Zhu noted that “clinicians should consider both the strength of individual risk factors and the cumulative weight of all risk factors prior to surgery [1].” The call for concern on risk assessment is also raised. In fact, pulmonary embolism is an unexpected problem that can be seen in any surgery. The problem can be seen in either obese or non-obese patients and is very hard to predict [2]. The standard classical pre-operative assessment usually lacks the ability to predict the problem. How to successfully predict the problem is the big issue. In a recent report, Pannucci et al. reported the new assessment tool that might be applicable [3]. Nevertheless, the verification in different settings is required. The important point should be the concern and awareness of the practitioners about the problem and early recognition and prompt management should be the important point to correspond to the problem.