title: Alvimopan: A cost-effective tool to decrease cystectomy length of stay.
abstract: BACKGROUND
  We sought to evaluate the cost effectiveness of perioperative use of alvimopan in cystectomy and urinary diversion. A recent randomized controlled trial demonstrated the efficacy of alvimopan in reducing postoperative ileus and length of stay in cystectomy; however, a major limitation was the exclusion of epidural analgesia.
  
  
  METHODS
  Eighty-six cystectomy and urinary diversion procedures performed by seven surgeons were analyzed between January 2008 and April 2012. The first 50 patients did not receive alvimopan perioperatively, while the subsequent 36 received a single dose of 12 mg preoperatively and then 12 mg every 12 hours for 15 doses or until discharge.
  
  
  RESULTS
  The groups were equal with respect to age, gender, indication, surgeon, and type of diversion. Patients who received alvimopan experienced a shorter length of stay (LOS) versus those in who did not receive alvimopan (10.5 vs. 8.6 days, p = 0.005, 95% CI 0.6-3.3). Readmission for ileus was low in both alvimopan and control groups (0% and 4.4%, respectively). Costs were significantly lower in the alvimopan group than the control groups (2012 USD 32,443 vs. 40,604 p <0.001). This difference stood up to multivariate analysis with a $7,062 difference in hospital stay.
  
  
  CONCLUSIONS
  Use of alvimopan in the routine perioperative care of our cystectomy and urinary diversion patients has decreased LOS by 1.9 days. Additionally, institution of routine perioperative alvimopan has reduced costs by $7,062 per admission (20% reduction). This demonstrates a real world application of alvimopan at a moderate volume center.
authors: University of Virginia, Department of Urology, Charlottesville, USA.
authors: Jules Powers
authors: JP
authors: Manger
authors: University of Virginia, Department of Urology, Charlottesville, USA.
authors: Marc
authors: M
authors: Nelson
authors: University of Virginia, Department of Urology, Charlottesville, USA.
authors: Shawnna
authors: S
authors: Blanchard
authors: Albany Medical Center, Division of Urology, Albany, USA.
authors: Sevann
authors: S
authors: Helo
authors: University of Virginia, Division of Biostatistics and Epidemiology, Charlottesville, USA.
authors: Mark
authors: M
authors: Conaway
authors: University of Virginia, Department of Urology, Charlottesville, USA.
authors: Tracey L
authors: TL
authors: Krupski
keywords: alvimopan; bladder cancer; cost–effectiveness; cystectomy; length–of–stay; urinary diversion