Alvimopan Provides Additional Improvement in Outcomes and Cost Savings in Enhanced Recovery Colorectal Surgery.
To examine the impact of alvimopan on outcomes and costs in a rigorous enhanced recovery colorectal surgery protocol.



Postoperative ileus remains a major source of morbidity and costs in colorectal surgery. Alvimopan has been shown to reduce incidence of postoperative ileus in enhanced recovery colorectal surgery; however, data are equivocal regarding its benefit in reducing length of stay and costs.



Patients undergoing major elective enhanced recovery colorectal surgery were identified from a prospectively-collected database (2010-2013). Multivariable analyses were employed to compare outcomes and hospital costs among patients who had alvimopan versus no alvimopan by adjusting for demographic, clinical, and treatment characteristics.



A total of 660 patients were included; 197 patients received alvimopan and 463 patients had no alvimopan. In unadjusted analysis, the alvimopan group had a faster return of bowel function, shorter length of stay, and lower rates of ileus, Foley re-insertion, and urinary tract infection (all P < 0.01). After adjustment, alvimopan was associated with a faster return of bowel function by 0.6 day (P = 0.0006), and lower incidence of postoperative ileus (odds ratio 0.23, P = 0.0002). With adjustment, alvimopan was associated with a shorter length of stay by 1.6 days (P = 0.002), and a hospital cost savings of $1492 per patient (P = 0.01).



Alvimopan administration as an element of enhanced recovery colorectal surgery is associated with faster return of bowel function, lower incidence of postoperative ileus, shorter hospitalization, and a significant cost savings. These results suggest that alvimopan is cost-effective in the setting of enhanced recovery colorectal surgery protocols, and should therefore be considered in these programs.
*Department of Surgery, Duke University Medical Center, Durham, NC†Department of Pharmacy, Duke University Medical Center, Durham, NC‡Department of Biostatistics, Duke University, Durham, NC.
Mohamed Abdelgadir
MA
Adam
Lacey M
LM
Lee
Jina
J
Kim
Mithun
M
Shenoi
Mohan
M
Mallipeddi
Hamza
H
Aziz
Sandra
S
Stinnett
Zhifei
Z
Sun
Christopher R
CR
Mantyh
Julie K M
JK
Thacker
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003107:Colorectal Surgery / Q000191:economics*; D017046:Cost Savings / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D045823:Ileus / Q000517:prevention & control*; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage* / Q000191:economics*; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D014481:United States
D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan