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Alvimopan improves outcomes after bowel resection

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – By accelerating recovery of gastrointestinal function, use of the opioid receptor antagonist alvimopan is associated with reduced mortality and morbidity following bowel resection, according to a report in the Annals of Surgery online March 1.

“In addition, postoperative LOS (with comparable readmission rates) and estimated cost were lower in patients who received alvimopan compared with matched controls after open or laparoscopic BR (bowel resection),” the authors comment.

Dr. Conor P. Delaney, with University Hospitals Case Medical Center, Case Western Reserve University in Cleveland, Ohio, and colleagues note that GI recovery after open and laparoscopic bowel resection is “a critical milestone,” with delays in recovery increasing the risk of postop complications.

While the peripherally acting mu-opioid receptor antagonist alvimopan has been approved by the US Food and Drug Administration for the accelerating GI recovery after open bowel resection, they continue, up to 40% of cases these days are performed laparoscopically.

The team examined in-hospital outcomes after open and laparoscopic bowel resection with or without alvimopan treatment in a retrospective study of data from a national inpatient database. “Each alvimopan patient was exact matched (surgical procedure, surgeon specialty) and propensity score-matched (baseline characteristics) to a non-alvimopan BR patient,” they explain.

Among the 3525 matched pairs, mortality rates were 0.4% versus 1.0% in the alvimopan and non-alvimopan groups, respectively, the report indicates. Corresponding morbidity rates were 29.8% vs 35.7% for GI complications, 19.4% vs 24.9% for cardiovascular events and 1.2% vs 2.1% for thromboembolic events. All differences were significant at a P value of 0.003 or less.

Mean postop length of stay was 5.3 days in the alvimopan group compared with 6.4 days in the control group, translating to a cost saving of $2345, Dr. Delaney and colleagues found. The LOS was reduced whether bowel resection was an open procedure (-1.8 days) or laparoscopic (-0.8 days), with corresponding savings of $3218 and $1382.

The authors conclude, “The data suggest that routine incorporation of alvimopan into standard BR care may improve early postoperative recovery and, thus, overall quality of care for patients undergoing these common major surgical procedures.”


Evaluation of Clinical Outcomes With Alvimopan in Clinical Practice: A National Matched-Cohort Study in Patients Undergoing Bowel Resection

Ann Surg 2012.