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The SMR analyses suggest that most of the relative risk is in the youngest population (more than fortyfold higher than expected), where VTE would normally be uncommon. The low cumulative incidence of symptomatic VTE in our population-based sample of patients undergoing knee arthroscopy is supported by previous studies. In a large retrospective cohort study of > 20?000 patients in the Kaiser Permanente health maintenance organization (California), the 90-day incidence of symptomatic VTE after knee arthroscopy was 0.4% (95% CI, 0.32�C0.49%) [9]; age > 50?years was also identified as a predictor of VTE (odds ratio = 1.54). Akt inhibitor Similarly, a retrospective cohort study of 2050 knee arthroscopy recipients reported a 0.24% incidence of symptomatic VTE [26]. Our study has several important strengths. Because of the extensive medical records linkage system and follow-up through the REP, we are able to report incidence using a population-based cohort with complete follow-up that includes the entire spectrum of arthroscopic knee surgeries and incident VTE occurring in the community. In additional, our study reports the more clinically-relevant incidence of symptomatic VTE after knee arthroscopy, rather than the incidence of asymptomatic VTE. Asymptomatic VTE detected with mandatory imaging is a poor surrogate outcome because it is clinically irrelevant and it does not allow clinicians to balance the benefit of preventing symptomatic VTE with the risk of bleeding [27]. Our study also has important limitations. The retrospective design limited our assessment of potential risk factors to those available from the medical records. In addition, the small number of outcomes limited our power to detect an effect. Further, we were unable to test other potentially important characteristics such as type of surgical procedure (diagnostic vs. therapeutic), tourniquet time, anesthesia time, and use of VTE prophylaxis. Because the Olmsted County population during the study time frame was predominantly non-Hispanic white, our results may not apply to different race and/or ancestry populations. Although our observed incidence of VTE after knee arthroscopy was fourteenfold higher than the expected incidence in a general population of similar age and sex, the overall incidence was still very low for a surgical procedure (0.4%). Furthermore, there was no difference in observed vs. expected survival in the 3?months after knee arthroscopy. For other types of non-orthopedic surgeries, the ACCP guidelines recommend no specific pharmacologic or mechanical prophylaxis other than early ambulation for patients at very low risk for VTE (<?0.5%) [28]. In the randomized trial comparing compression stockings with LMWH prophylaxis, the incidence of symptomatic VTE was 0.5% and 0.</div>
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