title: Alvimopan reduces length of stay and costs in patients undergoing segmental colonic resections: results from multicenter national administrative database.
abstract: BACKGROUND
  Alvimopan (Entereg), a peripherally acting mu-opioid receptor antagonist, has been shown to expedite recovery of bowel function after colon resection surgery. Most data are available from industry-sponsored trials. This study aims to evaluate the clinical impact of this drug on perioperative outcomes and costs in patients undergoing segmental colonic resection for diverticular disease.
  
  
  METHODS
  A large administrative database maintained by the University Health System Consortium, an alliance of over 200 academic and affiliate hospitals, was queried from 2008 to 2011. International Classification of Diseases, 9th Revision, Clinical Modification codes for segmental colon resection because of diverticular disease were used to identify 2 matched cohorts of adult patients. University Health System Consortium's clinical resource manager was used to access pharmacy data and compare it with patient outcomes.
  
  
  RESULTS
  Five thousand two hundred ninety-nine patients met the above criteria. Four hundred thirty-eight patients received alvimopan and 4,861 did not. Regardless of laparoscopic or open approach, alvimopan significantly improved the postoperative length of stay (4.43 ± 2.02 vs 5.92 ± 3.79, P < .0001), cost (9,974 ± 4,077 vs 11,303 ± 6,968, P < .0001), and intensive care unit admission rate (1.83% vs 7.20%, P < .05), with no significant difference in mortality (.0% vs .19%, P = 1.000), morbidity (5.93% vs 8.39%, P = .08), or 30-day readmission rate (4.40% vs 4.63%, P = .90).
  
  
  CONCLUSIONS
  Alvimopan significantly reduced length of stay, days in the intensive care unit, and hospital cost for patients undergoing colonic segmental resections. Unlike some previously reported studies, we also observed a significant reduction in the length of stay in patients undergoing laparoscopic colectomies who received the drug. Alvimopan may reduce total healthcare costs if used as part of a best care practice model for colon resections.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Simorov
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Thompson
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: doleynik@unmc.edu.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D010880:Piperidines / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan
keywords: Alvimopan; Colon; Database; Outcomes; Resection; Sigmoidectomy