Total knee replacement is the surgical procedure most commonly associated with chronic opioid use in opioid-naïve patients, according to a new study.

In a retrospective analysis, researchers from Stanford compared the records of more than 640,000 opioid-naïve surgical patients to more than 18 million opioid-naïve non-surgical patients. Researchers reviewed 11 surgical procedures, including knee and hip arthroplasty, laparoscopic and open cholecystectomies, appendectomies, C-sections, sinus surgery, cataract surgery, transurethral resections of the prostate (TURP), and simple mastectomies.

Chronic opioid use was defined as filling 10 or more prescriptions or more than 120 days’ supply of an opioid in the first year after surgery, excluding the first 90 postoperative days. Cataract surgery, sinus surgery, laparoscopic appendectomy, and TURP were not associated with chronic opioid use. For other procedures, C-sections had the lowest risk, while total knee replacement had the highest risk (1.41%; 95% confidence interval, 1.29%-1.53%). Men and elderly patients were at the highest risk for chronic opioid use (JAMA Intern Med Published online July 11, 2016. doi:10.1001/jamainternmed.2016.3298).