title: Does alvimopan enhance return of bowel function in laparoscopic gastrointestinal surgery? A meta-analysis.
abstract: BACKGROUND
  Postoperative ileus (POI) remains a major impediment in patient recovery and leads to longer lengths of stay at the hospital, readmission rates, and hospital costs. Alvimopan, a mu-opioid receptor antagonist, lowers POI incidence following open gastrointestinal surgery, however, little is known about its role on POI prevention among patients undergoing laparoscopic gastrointestinal surgery.
  
  
  METHODS
  A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess prevention of POI and hospital readmission.
  
  
  RESULTS
  Five studies were included in the final analysis. Pooling 4 of 5 studies, there was over a 75% relative risk reduction in POI development when patients were given alvimopan compared to placebo (OR 0.24, 95%CI 0.12-0.51, P=0.02). The number needed to treat with alvimopan to prevent one POI episode was 11 patients. There was a modest reduction in the length of hospitalization between 0.2 and 1.6 days. There did not appear to be a difference in frequency of 30-day readmission rate among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45, P=0.62).
  
  
  CONCLUSIONS
  Overall, there was a 75% relative risk reduction in POI development among patients undergoing laparoscopic gastrointestinal surgery. However, there did not appear to be a significant reduction in all-cause 30-day readmission rate or length of hospitalization. Future studies will need to address which subset of patients undergoing laparoscopic gastrointestinal surgery will benefit most from alvimopan.
authors.affiliation: Department of Medicine, University of California-Irvine, CA (Douglas L. Nguyen, Shelley Maithel), USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, University of California-Irvine, CA (Douglas L. Nguyen, Shelley Maithel), USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Maithel
authors.affiliation: Department of Pharmacy, University of California-Irvine, CA (Emily T. Nguyen), USA.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, University of Missouri-Columbia (Matthew L. Bechtold), USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
keywords: Alvimopan; laparoscopic gastrointestinal surgery; postoperative ileus