{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T21:41:11Z","timestamp":1782423671727,"version":"3.54.5"},"reference-count":23,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,11,9]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Several studies have identified excess risk associated with undergoing simultaneous (compared with unilateral or staged) bilateral total knee arthroplasty (BTKA). However, few have addressed subsequent chronic opioid use. Given the substantial morbidity and mortality associated with prolonged opioid use, we evaluated the incidence of postoperative chronic opioid use following simultaneous versus staged BTKA, based on the different timing strategies of staged procedures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this retrospective cohort study, patients who underwent BTKA procedures (2012\u20132016; Truven Health MarketScan; n=14 407) were classified as having undergone simultaneous or staged BTKA (&lt;3 months, 3\u20136 months or 6\u201312 months apart). Outcomes were postoperative chronic opioid use and oral morphine equivalents prescribed on discharge. Multivariable regression models measured associations between type\/timing of BTKA and outcomes. ORs and 95% CIs were reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Unadjusted frequency of chronic opioid use did not differ between groups, (Simultaneous: 11.3%, staged &lt;3 months: 10.7%, staged 3\u20136 months: 11.7%, staged &gt;6 months: 10.2%; p=0.247). In an adjusted model, there was no significant difference in the odds of becoming chronic opioid users between staged and simultaneous BTKA (staged &lt;3 months OR 1.03, 95% CI 0.88 to 1.21\/staged 3\u20136 months OR 0.94, 95% CI 0.79 to 1.12\/staged &gt;6 months OR 0.96, 95% CI 0.82 to 1.13; p=0.755). Patients undergoing staged BTKAs &lt;6 months apart (compared with simultaneous) were prescribed slightly greater oral morphine equivalents on hospital discharge (staged &lt;3 months 6% increase, 95% CI 3% to 10%; staged 3\u20136 months 4%, 95% CI 1% to 8%; p=0.002).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Although patients undergoing staged BTKA &lt;6 months apart were prescribed greater quantities of opioids on discharge, there was no significant difference in the odds of postoperative chronic opioid use compared with simultaneous BTKA. The timing of BTKA procedures does not appear to influence the likelihood of postoperative chronic opioid dependence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2020-102060","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T15:57:27Z","timestamp":1605887847000},"page":"405-409","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Risk of chronic opioid use after simultaneous versus staged bilateral knee arthroplasty"],"prefix":"10.1136","volume":"46","author":[{"given":"Lauren","family":"Wilson","sequence":"first","affiliation":[{"name":"Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Fiasconaro","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1029-2786","authenticated-orcid":false,"given":"Jiabin","family":"Liu","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA"},{"name":"Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-5102","authenticated-orcid":false,"given":"Jashvant","family":"Poeran","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaros","family":"Poultsides","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Medical Center, New York city, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9093-0030","authenticated-orcid":false,"given":"Stavros G","family":"Memtsoudis","sequence":"additional","affiliation":[{"name":"Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA"},{"name":"Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA"},{"name":"Department of Health Policy and Research, Weill Cornell Medical College, New York City, New York, USA"},{"name":"Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,11,20]]},"reference":[{"key":"2025101109555122000_46.5.405.1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20080801-23"},{"key":"2025101109555122000_46.5.405.2","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.RVW.N.00019","article-title":"Risks and benefits of simultaneous bilateral total knee arthroplasty: a critical analysis review","volume":"3","author":"Meehan","year":"2015","journal-title":"JBJS Rev"},{"key":"2025101109555122000_46.5.405.3","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00373"},{"key":"2025101109555122000_46.5.405.4","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01353"},{"key":"2025101109555122000_46.5.405.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-011-1287-4"},{"key":"2025101109555122000_46.5.405.6","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s11420-012-9315-7","article-title":"Simultaneous 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Simultaneous (two\u2010surgeon) versus staged bilateral knee arthroplasty: an observational study of intraoperative and post\u2010operative outcomes. 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