TY - JOUR
T1 - Is there value in alvimopan in minimally invasive colorectal surgery?
AU - Keller, Deborah S.
AU - Flores-Gonzalez, Juan Ramon
AU - Ibarra, Sergio
AU - Mahmood, Ali
AU - Haas, Eric M.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Alvimopan's goal is to minimize postoperative ileus and optimize outcomes; however, evidence in laparoscopic surgery is lacking. Our goal was to evaluate the benefit of alvimopan in laparoscopic colorectal surgery with an enhanced recovery pathway (ERP). Methods Laparoscopic colorectal cases were stratified into alvimopan and control cohorts, then case-matched for comparability. All followed an identical ERP. The main outcomes were length of stay, complications, readmissions, and costs in the alvimopan and control groups. Results About 321 patients were analyzed in each cohort. Operative times were comparable (P = .08). Postoperatively, complication rates were similar (P =.29), with no difference in ileus (P = 1.00). The length of stay (3.69 vs 3.49 days; P =.16), readmission (2.8% vs 3.7%; P =.66) and reoperation rates (2.2% vs 1.6%; P =.77) were comparable for alvimopan and controls, respectively. Total costs were similar ($14,932.47 alvimopan vs $14,846.56 controls; P =.90), but the additional costs in the alvimopan group could translate to savings of $27,577 in the cohort. Conclusions Alvimopan added no benefit in patient outcomes in laparoscopic colorectal surgery with an ERP. These results could drive a change in current practice. Controlled studies are warranted to define the cost and/or benefit in clinical practice.
AB - Background Alvimopan's goal is to minimize postoperative ileus and optimize outcomes; however, evidence in laparoscopic surgery is lacking. Our goal was to evaluate the benefit of alvimopan in laparoscopic colorectal surgery with an enhanced recovery pathway (ERP). Methods Laparoscopic colorectal cases were stratified into alvimopan and control cohorts, then case-matched for comparability. All followed an identical ERP. The main outcomes were length of stay, complications, readmissions, and costs in the alvimopan and control groups. Results About 321 patients were analyzed in each cohort. Operative times were comparable (P = .08). Postoperatively, complication rates were similar (P =.29), with no difference in ileus (P = 1.00). The length of stay (3.69 vs 3.49 days; P =.16), readmission (2.8% vs 3.7%; P =.66) and reoperation rates (2.2% vs 1.6%; P =.77) were comparable for alvimopan and controls, respectively. Total costs were similar ($14,932.47 alvimopan vs $14,846.56 controls; P =.90), but the additional costs in the alvimopan group could translate to savings of $27,577 in the cohort. Conclusions Alvimopan added no benefit in patient outcomes in laparoscopic colorectal surgery with an ERP. These results could drive a change in current practice. Controlled studies are warranted to define the cost and/or benefit in clinical practice.
KW - Alvimopan
KW - Enhanced recovery after surgery
KW - Health care outcomes
KW - Laparoscopic colorectal surgery
KW - Postoperative ileus
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U2 - 10.1016/j.amjsurg.2016.02.016
DO - 10.1016/j.amjsurg.2016.02.016
M3 - Article
C2 - 27262754
AN - SCOPUS:84973912652
VL - 212
SP - 851
EP - 856
JO - The American Journal of Surgery
JF - The American Journal of Surgery
SN - 0002-9610
IS - 5
ER -