title: A statewide, community-based assessment of alvimopan's effect on surgical outcomes.
abstract: OBJECTIVE
  Alvimopan was approved by the Food and Drug Administration in May 2008 and has been shown to accelerate gastrointestinal recovery after colectomy. Our independent study evaluated alvimopan as it is used in actual hospital practice in the state of Michigan. We hypothesized that alvimopan significantly decreases incidence of prolonged ileus and reduces length of stay (LOS) in patients who have undergone colectomy.
  
  
  METHODS
  We identified 4749 patients from the Michigan Surgical Quality Collaborative (N = 28 hospitals) database between August 2007 and December 2010 who underwent elective colectomy operations. A total of 528 patients received alvimopan both pre- and postoperatively. We first selected a control group of patients from hospitals that had never administered alvimopan (n = 1833) and used propensity matching to manage differences in patient demographics and clinical characteristics. To control for hospital and surgeon characteristics, we then performed a sensitivity analysis, using a separate group of historical control patients treated before May 2008 in hospitals that would later administer alvimopan (n = 270). The Fisher exact test was used to compare complication rates, and the Student t test was used to compare LOS.
  
  
  RESULTS
  Patients who received alvimopan had significantly lower incidence of prolonged ileus (2.3% vs 7.9%; P < 0.001) and a significantly shorter LOS (4.84 ± 4.54 vs 6.40 ± 4.45 days; P < 0.001) than control patients in hospitals that had never administered alvimopan. No differences were noted in these outcomes using sensitivity analysis.
  
  
  CONCLUSIONS
  This study suggests that the actual utilization of alvimopan leads to a reduction in prolonged ileus and LOS in patients who underwent colectomy. By accelerating postoperative recovery, alvimopan has the potential to benefit patients and health care systems by improving outcomes, ensuring patient comfort, and reducing cost.
authors: Academic Surgeon Development Program, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
authors: Calista M
authors: CM
authors: Harbaugh
authors: Shaza N
authors: SN
authors: Al-Holou
authors: Thomas S
authors: TS
authors: Bander
authors: Joseph D
authors: JD
authors: Drews
authors: Muazzum M
authors: MM
authors: Shah
authors: Michael N
authors: MN
authors: Terjimanian
authors: Shijie
authors: S
authors: Cai
authors: Darrell A
authors: DA
authors: Campbell
authors: Michael J
authors: MJ
authors: Englesbe
mesh_terms: D003082:Colectomy / Q000009:adverse effects*; D003108:Colonic Diseases / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay / Q000639:trends; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D011184:Postoperative Period; D020127:Recovery of Function / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan