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Alvimopan is associated with decreased length of stay for both open and laparoscopic segmental colectomy. Surgery 2019 10;166(4):483-488

Date

07/28/2019

Pubmed ID

31345565

DOI

10.1016/j.surg.2019.04.035

Scopus ID

2-s2.0-85069647050   1 Citation

Abstract

BACKGROUND: Alvimopan has been shown to reduce length of stay after bowel resection. Use remains variable among institutions due to cost and efficacy concerns in laparoscopic surgery. Additionally, alvimopan's effects have not been isolated from other medications within enhanced recovery protocols. The aim of this study was to distinguish the relationship between alvimopan use, length of stay, and cost in both open and laparoscopic segmental colectomies.

METHODS: The Vizient dataset was queried to identify patients undergoing open and laparoscopic colectomies from 2015 to 2017. Patient demographics and treatment details were collected. Primary outcomes of interest included duration of stay and total direct costs.

RESULTS: In the study, 12,727 patients met inclusion criteria and 3,358 (26.4%) received alvimopan. For both open and laparoscopic groups, alvimopan was associated with decreased length of stay in unadjusted (4.0 vs 6.0 days, P < .01 and 3.0 vs 4.0 days, P < .01, respectively) and adjusted analysis (effect ratio 0.79, P < .01 and 0.85, P < .01, respectively). Alvimopan was associated with a 7% decrease in direct cost after adjustment (effect ratio 0.93, P = .04), with no cost difference in laparoscopic procedures (effect ratio 0.99, P = .71).

CONCLUSION: Alvimopan use is associated with decreased length of stay for both open and laparoscopic colon resections, decreased cost in open procedures, and no cost difference for laparoscopic procedures.

Author List

Henning RE, Hu KY, Rein LE, Szabo A, Peterson CY, Ludwig KA, Ridolfi TJ

Authors

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Carrie Peterson MD, MS, FACS, FASCRS Associate Professor in the Surgery department at Medical College of Wisconsin
Timothy J. Ridolfi MD Associate Professor in the Surgery department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Cohort Studies
Colectomy
Cost Savings
Databases, Factual
Elective Surgical Procedures
Female
Gastrointestinal Agents
Health Care Costs
Humans
Laparoscopy
Laparotomy
Length of Stay
Linear Models
Male
Middle Aged
Multivariate Analysis
Piperidines
Postoperative Complications
Retrospective Studies
United States
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a