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Alvimopan Provides Additional Improvement in Outcomes and Cost Savings in Enhanced Recovery Colorectal Surgery

Adam, Mohamed Abdelgadir MD; Lee, Lacey M. PharmD, BCPS; Kim, Jina MD; Shenoi, Mithun MD, PhD; Mallipeddi, Mohan MD; Aziz, Hamza MD; Stinnett, Sandra DPH; Sun, Zhifei MD; Mantyh, Christopher R. MD; Thacker, Julie K. M. MD

doi: 10.1097/SLA.0000000000001428
ORIGINAL ARTICLES
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Objective: To examine the impact of alvimopan on outcomes and costs in a rigorous enhanced recovery colorectal surgery protocol.

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Reprints: Julie K. M. Thacker, MD, Department of Surgery, Duke University Medical Center, Rm 7678 HAFS, DN, Durham, NC 27710. E-mail: Julie.thacker@duke.edu.

The authors declare no financial conflicts of interest.

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