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A Statewide, Community-Based Assessment of Alvimopan's Effect on Surgical Outcomes

Harbaugh, Calista M. BS; Al-Holou, Shaza N. BS; Bander, Thomas S. BS; Drews, Joseph D. BS; Shah, Muazzum M. BS; Terjimanian, Michael N. MS; Cai, Shijie MS; Campbell, Darrell A. Jr MD, FACS; Englesbe, Michael J. MD

doi: 10.1097/SLA.0b013e31826c37f1
Original Articles

Objective: Alvimopan was approved by the Food and Drug Administration in May 2008 and has been shown to accelerate gastrointestinal recovery after colectomy. Our independent study evaluated alvimopan as it is used in actual hospital practice in the state of Michigan. We hypothesized that alvimopan significantly decreases incidence of prolonged ileus and reduces length of stay (LOS) in patients who have undergone colectomy.

Methods: We identified 4749 patients from the Michigan Surgical Quality Collaborative (N = 28 hospitals) database between August 2007 and December 2010 who underwent elective colectomy operations. A total of 528 patients received alvimopan both pre- and postoperatively. We first selected a control group of patients from hospitals that had never administered alvimopan (n = 1833) and used propensity matching to manage differences in patient demographics and clinical characteristics. To control for hospital and surgeon characteristics, we then performed a sensitivity analysis, using a separate group of historical control patients treated before May 2008 in hospitals that would later administer alvimopan (n = 270). The Fisher exact test was used to compare complication rates, and the Student t test was used to compare LOS.

Results: Patients who received alvimopan had significantly lower incidence of prolonged ileus (2.3% vs 7.9%; P < 0.001) and a significantly shorter LOS (4.84 ± 4.54 vs 6.40 ± 4.45 days; P < 0.001) than control patients in hospitals that had never administered alvimopan. No differences were noted in these outcomes using sensitivity analysis.

Conclusion: This study suggests that the actual utilization of alvimopan leads to a reduction in prolonged ileus and LOS in patients who underwent colectomy. By accelerating postoperative recovery, alvimopan has the potential to benefit patients and health care systems by improving outcomes, ensuring patient comfort, and reducing cost.

This study investigates the utilization and efficacy of alvimopan, a drug used for gastrointestinal recovery, as it is administered to patients undergoing colectomy within community-based settings in the state of Michigan.

From the Academic Surgeon Development Program, Department of Surgery, University of Michigan, Ann Arbor.

Reprints: Michael J. Englesbe, MD, Department of Surgery, University of Michigan Medical School, 2926A Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109. E-mail:

Disclosure: D.A.C. is the project director of a grant entitled “The Michigan Surgical Quality Collaborative,” for which he receives 20% salary support from the Blue Cross and Blue Shield of Michigan/The Blue Care Network (BCBSM/BCN). M.J.E. was supported by the NIH-NIDDK (grant no. K08 DK0827508) and the BCBSM/BCN. The remaining authors have no financial arrangement or affiliation with a corporate organization or manufacturer of a product discussed in this article.

© 2013 Lippincott Williams & Wilkins, Inc.