title: Redefining the implications of nasogastric tube placement following radical cystectomy in the alvimopan era.
abstract: OBJECTIVE
  Alvimopan has decreased ileus and need for nasogastric tube (NGT) after radical cystectomy (RC). However, the natural history of ileus versus intestinal obstruction in patients receiving alvimopan is not well defined. We sought to examine the implications of NGT placement before and after the introduction of alvimopan for RC patients.
  
  
  METHODS
  Retrospective review identified 278 and 293 consecutive patients who underwent RC before and after instituting alvimopan between June 2009 and May 2014. Baseline characteristics and postoperative outcomes were compared by alvimopan status. Multivariate logistic regression was performed to assess the impact of alvimopan on rates of NGT placement and reoperation for bowel complications.
  
  
  RESULTS
  The cohorts had similar age, stage, approach, and BMI. Patients receiving alvimopan had decreased ileus (16 vs 32 %, p < 0.01) but similar rates of reoperation for bowel complications (2.8 vs 2.7 %). On multivariate analysis, alvimopan was associated with lower risk of NGT placement (OR 0.30, p < 0.01). For patients requiring NGT placement, there was an increased rate of reoperation among patients receiving alvimopan compared with those who did not (28 vs 11 %, p = 0.03). Patients receiving alvimopan who needed NGT had significantly increased median length of stay (22 vs 7 days), need for TPN (66 vs 5.3 %), and readmission for ileus (10.3 vs 2.3 %) compared with those who did not require NGT.
  
  
  CONCLUSIONS
  Alvimopan significantly reduced the incidence of ileus and NGT placement following RC. NGT placement was associated with an increased need for reoperation for bowel complications in the setting of alvimopan.
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA. vignesh.packiam@uchospitals.edu.
authors.forename: Vignesh T
authors.initials: VT
authors.lastname: Packiam
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA.
authors.forename: Vijay A
authors.initials: VA
authors.lastname: Agrawal
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Pariser
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cohen
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA.
authors.forename: Charles U
authors.initials: CU
authors.lastname: Nottingham
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Pearce
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA.
authors.forename: Norm D
authors.initials: ND
authors.lastname: Smith
authors.affiliation: Section of Urology, University of Chicago, Chicago, IL, USA.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D045823:Ileus / Q000517:prevention & control*; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010880:Piperidines / Q000627:therapeutic use*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
chemical_list: D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan
keywords: Alvimopan; Cystectomy; Intestinal obstruction; Reoperation; Urinary bladder neoplasms