• Mohamed Abdelgadir Adam, Lacey M Lee, Jina Kim, Mithun Shenoi, Mohan Mallipeddi, Hamza Aziz, Sandra Stinnett, Zhifei Sun, Christopher R Mantyh, and Julie K M Thacker.
• *Department of Surgery, Duke University Medical Center, Durham, NC†Department of Pharmacy, Duke University Medical Center, Durham, NC‡Department of Biostatistics, Duke University, Durham, NC.
• Ann. Surg. 2016 Jul 1; 264 (1): 141-6.

ObjectiveTo examine the impact of alvimopan on outcomes and costs in a rigorous enhanced recovery colorectal surgery protocol.BackgroundPostoperative ileus remains a major source of morbidity and costs in colorectal surgery. Alvimopan has been shown to reduce incidence of postoperative ileus in enhanced recovery colorectal surgery; however, data are equivocal regarding its benefit in reducing length of stay and costs.MethodsPatients undergoing major elective enhanced recovery colorectal surgery were identified from a prospectively-collected database (2010-2013). Multivariable analyses were employed to compare outcomes and hospital costs among patients who had alvimopan versus no alvimopan by adjusting for demographic, clinical, and treatment characteristics.ResultsA total of 660 patients were included; 197 patients received alvimopan and 463 patients had no alvimopan. In unadjusted analysis, the alvimopan group had a faster return of bowel function, shorter length of stay, and lower rates of ileus, Foley re-insertion, and urinary tract infection (all P < 0.01). After adjustment, alvimopan was associated with a faster return of bowel function by 0.6 day (P = 0.0006), and lower incidence of postoperative ileus (odds ratio 0.23, P = 0.0002). With adjustment, alvimopan was associated with a shorter length of stay by 1.6 days (P = 0.002), and a hospital cost savings of $1492 per patient (P = 0.01).ConclusionsAlvimopan administration as an element of enhanced recovery colorectal surgery is associated with faster return of bowel function, lower incidence of postoperative ileus, shorter hospitalization, and a significant cost savings. These results suggest that alvimopan is cost-effective in the setting of enhanced recovery colorectal surgery protocols, and should therefore be considered in these programs.

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