title: A meta-analysis of the effectiveness of the opioid receptor antagonist alvimopan in reducing hospital length of stay and time to GI recovery in patients enrolled in a standardized accelerated recovery program after abdominal surgery.
abstract: BACKGROUND
  Despite accelerated recovery programs and the widespread uptake of laparoscopic surgery, postoperative ileus remains a significant factor affecting length of stay after abdominal surgery. Alvimopan, an opioid-receptor antagonist, may reduce the incidence of postoperative ileus and expedite hospital discharge.
  
  
  OBJECTIVE
  The aim of this study was to perform a meta-analysis to determine the role of alvimopan in accelerating GI recovery and hospital discharge after laparoscopic and open abdominal surgery performed within an accelerated recovery program.
  
  
  METHODS
  Cochrane (1999-2010), Embase (1980-2010), MEDLINE (1980-2010), and International Pharmaceutical Abstracts (1970-2010) were searched for relevant double-blinded, randomized controlled trials.
  
  
  METHODS
  Twelve milligrams of alvimopan and placebo were given to patients enrolled in an accelerated recovery program after abdominal surgery.
  
  
  METHODS
  The primary outcomes measured were the length of stay as defined by the writing of the hospital discharge order and GI-3 and GI-2 GI tract recovery.
  
  
  RESULTS
  : Three trials were included that reported on a pooled modified intention-to-treat population of 1388 patients; 685 (49%) patients received alvimopan. On meta-analysis, alvimopan reduced time to the hospital discharge order (HR 1.37 (1.21, 1.62), p < 0.0001), GI-3 recovery (HR 1.42 (1.25, 1.62), p < 0.001), and GI-2 recovery (HR 1.49 (1.32, 1.68), p < 0.0001).
  
  
  CONCLUSIONS
  The search criteria identified only a small number of trials of alvimopan after abdominal surgery with no randomized trials of alvimopan after laparoscopic surgery. In addition, the use of length of hospital stay as the primary outcome measure may be inappropriate, because it is open to many confounding factors. Finally, adverse events, in particular, adverse cardiovascular events, were not considered.
  
  
  CONCLUSIONS
  Alvimopan 12 mg can further reduce time to GI recovery and hospital discharge in patients undergoing abdominal surgery within an accelerated recovery program. Investigation into the effect of alvimopan following laparoscopic surgery and additional cost-benefit analyses are required to further define the role of this intervention.
authors.affiliation: Department of Lower GI Surgery, Southampton University Hospitals NHS Trust, Southampton, United Kingdom.
authors.forename: P G
authors.initials: PG
authors.lastname: Vaughan-Shaw
authors.forename: I C
authors.initials: IC
authors.lastname: Fecher
authors.forename: S
authors.initials: S
authors.lastname: Harris
authors.forename: J S
authors.initials: JS
authors.lastname: Knight
mesh_terms: D013505:Digestive System Surgical Procedures; D041981:Gastrointestinal Tract / Q000502:physiology*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D010880:Piperidines / Q000494:pharmacology*; D011182:Postoperative Care / Q000379:methods*; D015397:Program Evaluation; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors*; D020127:Recovery of Function / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D010880:Piperidines; D017450:Receptors, Opioid, mu; C419502:alvimopan