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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

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:

© 2019 The American Society of Colon and Rectal Surgeons