Alvimopan use in laparoscopic and open bowel resections: clinical results in a large community hospital system.
BACKGROUND
Alvimopan has received Food and Drug Administration approval to accelerate the time to upper and lower gastrointestinal recovery following partial large or small bowel resection with primary anastomosis.


OBJECTIVE
To assess the efficacy, safety, and economic benefit of alvimopan in patients undergoing open or laparoscopic bowel resection in a community hospital system setting.


METHODS
This 6-month, open-label, multi-hospital, prospective study combined with a retrospective chart review compared postoperative length of stay and postoperative ileus-related morbidity (nasogastric tube insertion, hospital readmission) for patients undergoing open or laparoscopic bowel resection who received alvimopan 12 mg (n = 108) versus historical control bowel resection patients (n = 91) who would have been eligible to receive alvimopan. Multivariate analysis assessed the effects of age and surgery type on postoperative length of stay. Additional-day hospital costs were estimated using ordinary least-squares regression to calculate costs based on length of stay in the control cohort.


RESULTS
Compared with historical controls, patients receiving alvimopan had a mean 1.8-day shorter postoperative length of stay (p = 0.01) and lower rates of nasogastric tube insertion (2% vs 15%, p < 0.001). Multivariate analysis revealed a statistically significant reduction in postoperative length of stay in the alvimopan group of approximately 1.2 days (p = 0.01), regardless of age or surgery type, with an even larger difference (3.2 days) observed in patients ≥70 years old. Mean cost savings associated with alvimopan use ranged from $531 (laparoscopic bowel resection) to $997 (open bowel resection) per patient.


CONCLUSIONS
Consistent with clinical trial data, alvimopan use resulted in an approximately 1 day shorter postoperative length of stay and was associated with substantial cost savings.
Absher
Randall K
RK
Wesley Long Community Hospital Pharmacy, Moses Cone Health System, Greensboro, NC, USA. Randy.Absher@mosescone.com
Gerkin
Todd M
TM
Banares
Linda W
LW
D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D017046:Cost Savings; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006764:Hospitals, Community; D006801:Humans; D045823:Ileus / Q000453:epidemiology; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy / Q000379:methods; D016018:Least-Squares Analysis; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010880:Piperidines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies
D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan