Is there value in alvimopan in minimally invasive colorectal surgery?

Deborah S. Keller, Juan Ramon Flores-Gonzalez, Sergio Ibarra, Ali Mahmood, Eric M. Haas

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)851-856
Number of pages6
JournalAmerican Journal of Surgery
Volume212
Issue number5
DOIs
StatePublished - Nov 1 2016

Keywords

  • Alvimopan
  • Enhanced recovery after surgery
  • Health care outcomes
  • Laparoscopic colorectal surgery
  • Postoperative ileus

ASJC Scopus subject areas

  • Surgery

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