Abstract
Background
Alvimopan (Entereg), a peripherally acting mu-opioid receptor antagonist, has been
shown to expedite recovery of bowel function after colon resection surgery. Most data
are available from industry-sponsored trials. This study aims to evaluate the clinical
impact of this drug on perioperative outcomes and costs in patients undergoing segmental
colonic resection for diverticular disease.
Methods
A large administrative database maintained by the University Health System Consortium,
an alliance of over 200 academic and affiliate hospitals, was queried from 2008 to
2011. International Classification of Diseases, 9th Revision, Clinical Modification
codes for segmental colon resection because of diverticular disease were used to identify
2 matched cohorts of adult patients. University Health System Consortium's clinical
resource manager was used to access pharmacy data and compare it with patient outcomes.
Results
Five thousand two hundred ninety-nine patients met the above criteria. Four hundred
thirty-eight patients received alvimopan and 4,861 did not. Regardless of laparoscopic
or open approach, alvimopan significantly improved the postoperative length of stay
(4.43 ± 2.02 vs 5.92 ± 3.79, P < .0001), cost (9,974 ± 4,077 vs 11,303 ± 6,968, P < .0001), and intensive care unit admission rate (1.83% vs 7.20%, P < .05), with no significant difference in mortality (.0% vs .19%, P = 1.000), morbidity (5.93% vs 8.39%, P = .08), or 30-day readmission rate (4.40% vs 4.63%, P = .90).
Conclusions
Alvimopan significantly reduced length of stay, days in the intensive care unit, and
hospital cost for patients undergoing colonic segmental resections. Unlike some previously
reported studies, we also observed a significant reduction in the length of stay in
patients undergoing laparoscopic colectomies who received the drug. Alvimopan may
reduce total healthcare costs if used as part of a best care practice model for colon
resections.
Keywords
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Article info
Publication history
Published online: September 20, 2014
Received in revised form:
August 18,
2014
Received:
April 9,
2014
Footnotes
The authors declare no conflicts of interest.
There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
This work was supported by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
