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Alvimopan Significantly Reduces Length of Stay and Costs Following Colorectal Resection and Ostomy Reversal Even Within an Enhanced Recovery Protocol

Hyde, Laura Z. M.D., M.P.H.1,2; Kiely, James Mark M.D.1; Al-Mazrou, Ahmed M.B.B.S.1; Zhang, Haiqing M.D.1; Lee-Kong, Steven M.D.1; Kiran, Ravi Pokala M.B.B.S., M.S., M.Sc. (E.B.M.)1

Diseases of the Colon & Rectum: June 2019 - Volume 62 - Issue 6 - p 755–761
doi: 10.1097/DCR.0000000000001354
Original Contributions: Socioeconomic
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BACKGROUND: Alvimopan accelerates GI recovery after colorectal resection. Data on real-world cost-effectiveness have been mixed.

OBJECTIVE: This study aimed to evaluate if adding alvimopan to an enhanced recovery pathway reduces length of stay.

DESIGN: Patients undergoing colorectal resection or ostomy reversal for the year before and after the introduction of alvimopan were evaluated.

SETTING: This study was conducted at a single academic medical center.

PATIENTS: Patients undergoing elective colorectal resection (488) or ostomy reversal (148) were included.

MAIN OUTCOME MEASURES: The primary outcomes measured were length of stay and prolonged length of stay defined as >75th percentile for each procedure.

RESULTS: Two hundred eighty-six patients (45%) received alvimopan. Alvimopan and no-alvimopan groups had similar demographics, comorbidities, operative indication, and case mix. In the alvimopan group, more of the colorectal resections were laparoscopic (87% vs 79%, p = 0.015). Length of stay was reduced with alvimopan (6.2 vs 4.9 days, p = 0.003), and this effect persisted when controlling for procedure type, approach, and ASA class (decreased length of stay by 1.0 day, p = 0.014). The alvimopan group had lower risk of prolonged length of stay (14.7% vs 23.1%, p = 0.007) and ileus (10.8% vs 16.2%, p = 0.05). On multivariable analysis, no alvimopan use (OR, 1.8; 95% CI, 1.2–2.7), ASA ≥3 (OR, 2.0; 95% CI, 1.3–3.1), and history of cardiac surgery (OR, 2.8; 95% CI, 1.2–6.5) were significant predictors of prolonged length of stay. Alvimopan use was associated with a lower risk of infectious complications other than surgical site infection (2.8% vs 6.7%, p = 0.025), and did not increase risk of any adverse outcomes. The addition of alvimopan to the protocol resulted in cost savings of $708.39 per patient.

LIMITATIONS: Data collected from a single center limit external validity.

CONCLUSIONS: The introduction of alvimopan to a postoperative protocol following elective colorectal resection or ostomy reversal significantly reduces length of stay and is associated with cost savings even within an enhanced recovery protocol. See Video Abstract at http://links.lww.com/DCR/A911.

1 Division of Colorectal Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York

2 Department of Surgery, University of California San Francisco-East Bay, Oakland, California

Funding/Support: None reported

Financial Disclosures: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23. 2018.

Correspondence: James Mark Kiely, M.D., 161 Fort Washington Ave, New York, NY 10032. E-mail: jmk2270@cumc.columbia.edu

© 2019 The American Society of Colon and Rectal Surgeons