Alvimopan Use, Outcomes, and Costs: A Report from the Surgical Care and Outcomes Assessment Program Comparative Effectiveness Research Translation Network Collaborative.
Randomized trials have found that alvimopan hastens return of bowel function and reduces length of stay (LOS) by 1 day among patients undergoing colorectal surgery. However, its effectiveness in routine clinical practice and its impact on hospital costs remain uncertain.



We performed a retrospective cohort study of patients undergoing elective colorectal surgery in Washington state (2009 to 2013) using data from a clinical registry (Surgical Care and Outcomes Assessment Program) linked to a statewide hospital discharge database (Comprehensive Hospital Abstract Reporting System). We used generalized estimating equations to evaluate the relationship between alvimopan and outcomes, and adjusted for patient, operative, and management characteristics. Hospital charges were converted to costs using hospital-specific charge to cost ratios, and were adjusted for inflation to 2013 US dollars.



Among 14,781 patients undergoing elective colorectal surgery at 51 hospitals, 1,615 (11%) received alvimopan. Patients who received alvimopan had a LOS that was 1.8 days shorter (p < 0.01) and costs that were $2,017 lower (p < 0.01) compared with those who did not receive alvimopan. After adjustment, LOS was 0.9 days shorter (p < 0.01), and hospital costs were $636 lower (p = 0.02) among those receiving alvimopan compared with those who did not.



When used in routine clinical practice, alvimopan was associated with a shorter LOS and limited but significant hospital cost savings. Both efficacy and effectiveness data support the use of alvimopan in routine clinical practice, and its use could be measured as a marker of higher quality care.
Department of Surgery, University of Washington, Seattle, WA. Electronic address: apugel@uw.edu.
Anne P
AP
Ehlers
Department of Surgery, University of Washington, Seattle, WA.
Vlad V
VV
Simianu
Department of Surgery, Swedish Medical Center, Seattle, WA.
Amir L
AL
Bastawrous
Department of Surgery, University of Washington, Seattle, WA.
Richard P
RP
Billingham
Department of Surgery, University of Washington, Seattle, WA.
Giana H
GH
Davidson
Department of Surgery, University of Washington, Seattle, WA.
Alessandro
A
Fichera
Department of Surgery, Swedish Medical Center, Seattle, WA.
Michael G
MG
Florence
Department of Surgery, Swedish Medical Center, Seattle, WA.
Raman
R
Menon
Department of Surgery, Virginia Mason Medical Center, Seattle, WA.
Richard C
RC
Thirlby
Department of Surgery, University of Washington, Seattle, WA.
David R
DR
Flum
Department of Surgery, University of Washington, Seattle, WA.
Farhood
F
Farjah
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000191:economics / Q000706:statistics & numerical data*; D003106:Colon / Q000601:surgery; D057186:Comparative Effectiveness Research; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use*; D012007:Rectum / Q000601:surgery; D012042:Registries; D057170:Translational Research, Biomedical; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan