Alvimopan addition to a standard perioperative recovery pathway.
OBJECTIVE
Alvimopan, a peripherally acting mu-opioid receptor antagonist, decreased time to gastrointestinal recovery and hospital length of stay in open bowel resection patients in Phase 3 trials. However, the benefit in laparoscopic colectomy patients remains  unclear.


METHODS
A retrospective case series review was performed to study addition of alvimopan to a well-established standard perioperative recovery pathway for elective laparoscopic colectomy. The main outcome measures were length of stay and incidence of charted postoperative  ileus. Wilcoxon and chi-square tests were used to calculate P values for length of stay and postoperative ileus endpoints, respectively.


RESULTS
Demographic/baseline characteristics from the 101 alvimopan and 64 pre-alvimopan control patients were generally comparable. Mean length  of stay in the alvimopan group was 1.55 days shorter (alvimopan, 2.81±0.95 days; control, 4.36±2.4 days; P<.0001). The proportion of patients with postoperative ileus was lower in the alvimopan group (alvimopan, 2%; control, 20%; P<.0001).


CONCLUSIONS
In this  case series, addition of alvimopan to a standard perioperative recovery pathway decreased length of stay and incidence of postoperative ileus for elective uncomplicated laparoscopic colectomy. The improvement in the mean length of stay for patients who receive alvimopan is a step forward in  achieving a fasttrack surgery model for elective laparoscopic colectomies.
Greater Baltimore Medical Center, Towson, MD, USA.
Edward A
EA
Itawi
Lisa M
LM
Savoie
Amy J
AJ
Hanna
George Y
GY
Apostolides
D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D016012:Poisson Distribution; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors; D020127:Recovery of Function / Q000187:drug effects; D012189:Retrospective Studies; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D010880:Piperidines; D017450:Receptors, Opioid, mu; C419502:alvimopan