title: Introduction of alvimopan into an enhanced recovery protocol for colectomy offers benefit in open but not laparoscopic colectomy.
abstract: BACKGROUND
  Alvimopan coupled with an enhanced recovery protocol (ERP) has been shown to reduce length of stay (LOS) after open colectomy, but its role after laparoscopy remains unknown. This study evaluated alvimopan with an established ERP for laparoscopic (LAP), hand-assisted laparoscopic (HAL), and open colectomy.
  
  
  METHODS
  Consecutive patients who underwent elective colectomy by any technique were retrospectively identified. Patients were excluded if they developed a major intra-abdominal complication, medical complication, or had a complex preoperative evaluation. Patients were stratified into 4 groups based on the surgical approach (open/HAL vs. LAP) and the use of alvimopan. All patients were managed by using an ERP. The incidence of postoperative ileus (POI) and LOS were compared between alvimopan and control groups for each surgical approach.
  
  
  RESULTS
  There were 282 patients. Demographics were similar across the 4 groups. The mean number of alvimopan doses administered was 6.7±2.6. For patients in the open/HAL group (n=149), the incidence of primary ileus was 9.5% (7/74) and 16% (12/75) for alvimopan and control patients, respectively (P=.231). A significant decrease in LOS was noted with alvimopan (5.6±2.5 vs. 6.8±3.3 days, P=.009). For patients after LAP (n=133), there was no significance difference in POI with or without alvimopan (3.9% [3/76] vs. 3.5% [2/57], P=1.00). There was no difference in LOS (3.9±1 vs. 3.7±1.4 days, P=.305).
  
  
  CONCLUSIONS
  The addition of alvimopan to an established ERP will lead to improvement in clinical outcomes in patients after open/HAL colectomy. The benefit of alvimopan after LAP remains negligible.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, Glendale, Arizona, USA. jbarle@midwestern.edu
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
authors.forename: Theodor
authors.initials: T
authors.lastname: Asgeirsson
authors.forename: Khaled I
authors.initials: KI
authors.lastname: El-Badawi
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
mesh_terms: D002985:Clinical Protocols; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies
chemical_list: D010880:Piperidines; D017450:Receptors, Opioid, mu; C419502:alvimopan