Background 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.
Methods In this retrospective cohort study, patients who underwent BTKA procedures (2012–2016; Truven Health MarketScan; n=14 407) were classified as having undergone simultaneous or staged BTKA (<3 months, 3–6 months or 6–12 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.
Results Unadjusted frequency of chronic opioid use did not differ between groups, (Simultaneous: 11.3%, staged <3 months: 10.7%, staged 3–6 months: 11.7%, staged >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 <3 months OR 1.03, 95% CI 0.88 to 1.21/staged 3–6 months OR 0.94, 95% CI 0.79 to 1.12/staged >6 months OR 0.96, 95% CI 0.82 to 1.13; p=0.755). Patients undergoing staged BTKAs <6 months apart (compared with simultaneous) were prescribed slightly greater oral morphine equivalents on hospital discharge (staged <3 months 6% increase, 95% CI 3% to 10%; staged 3–6 months 4%, 95% CI 1% to 8%; p=0.002).
Conclusion Although patients undergoing staged BTKA <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.
- chronic pain
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Contributors LW: This author helped in study design/planning, data analysis, interpretation of results, manuscript preparation and review. MF: This author helped in study design/planning, interpretation of results, manuscript preparation and review. JL: This author helped in study design/planning, interpretation of results and manuscript review. JP: This author helped in study design/planning, interpretation of results, manuscript preparation and review. LP: This author helped in study design/planning, interpretation of results and manuscript review. SGM: This author helped in study design/planning, interpretation of results, manuscript preparation and review.
Funding This study was funded internally by the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery.
Competing interests SGM is a director on the boards of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Society of Anesthesia and Sleep Medicine (SASM). He is a one-time consultant for Sandoz and Teikoku and is currently on the medical advisory board of HATH. He has a pending US Patent application for a Multicatheter Infusion System. US-2017-0361063. He is the owner of SGM Consulting, LLC and coowner of FC Monmouth, LLC. None of the above relations influenced the conduct of the present study. All other authors declare no conflicts of interest.
Patient consent for publication Not required.
Ethics approval Approval for this retrospective cohort study was obtained from the Institutional Review Board at Hospital for Special Surgery (IRB #2017–0169).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data are available via an institutional agreement with Truven MarketScan.