Is there value in alvimopan in minimally invasive colorectal surgery?
BACKGROUND
Alvimopan's goal is to minimize postoperative ileus and optimize outcomes; however, evidence in laparoscopic surgery is lacking. Our goal was to evaluate the benefit of alvimopan in laparoscopic colorectal surgery with an enhanced recovery pathway (ERP).


METHODS
Laparoscopic colorectal cases were stratified into alvimopan and control cohorts, then case-matched for comparability. All followed an identical ERP. The main outcomes were length of stay, complications, readmissions, and costs in the alvimopan and control groups.


RESULTS
About 321 patients were analyzed in each cohort. Operative times were comparable (P = .08). Postoperatively, complication rates were similar (P = .29), with no difference in ileus (P = 1.00). The length of stay (3.69 vs 3.49 days; P = .16), readmission (2.8% vs 3.7%; P = .66) and reoperation rates (2.2% vs 1.6%; P = .77) were comparable for alvimopan and controls, respectively. Total costs were similar ($14,932.47 alvimopan vs $14,846.56 controls; P = .90), but the additional costs in the alvimopan group could translate to savings of $27,577 in the cohort.


CONCLUSIONS
Alvimopan added no benefit in patient outcomes in laparoscopic colorectal surgery with an ERP. These results could drive a change in current practice. Controlled studies are warranted to define the cost and/or benefit in clinical practice.
Colorectal Surgical Associates, Houston, TX, USA; Department of Surgery, Houston Methodist Hospital, 7900 Fannin, Suite 2700, Houston, TX 77054, USA. Electronic address: debby_keller@hotmail.com.
Deborah S
DS
Keller
Colorectal Surgical Associates, Houston, TX, USA.
Juan-Ramon
JR
Flores-Gonzalez
Colorectal Surgical Associates, Houston, TX, USA.
Sergio
S
Ibarra
Colorectal Surgical Associates, Houston, TX, USA; Department of Surgery, Houston Methodist Hospital, 7900 Fannin, Suite 2700, Houston, TX 77054, USA; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX, USA.
Ali
A
Mahmood
Colorectal Surgical Associates, Houston, TX, USA; Department of Surgery, Houston Methodist Hospital, 7900 Fannin, Suite 2700, Houston, TX 77054, USA; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX, USA.
Eric M
EM
Haas
D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010880:Piperidines / Q000008:administration & dosage* / Q000191:economics; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D020127:Recovery of Function; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan
Alvimopan; Enhanced recovery after surgery; Health care outcomes; Laparoscopic colorectal surgery; Postoperative ileus