Alvimopan Provides Additional Improvement in Outcomes and Cost Savings in Enhanced Recovery Colorectal Surgery.
Ann Surg
; 264(1): 141-6, 2016 07.
Article
em En
| MEDLINE
| ID: mdl-26501697
ABSTRACT
OBJECTIVE:
To examine the impact of alvimopan on outcomes and costs in a rigorous enhanced recovery colorectal surgery protocol.BACKGROUND:
Postoperative 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.METHODS:
Patients 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.RESULTS:
A 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 Pâ<â0.01). After adjustment, alvimopan was associated with a faster return of bowel function by 0.6 day (Pâ=â0.0006), and lower incidence of postoperative ileus (odds ratio 0.23, Pâ=â0.0002). With adjustment, alvimopan was associated with a shorter length of stay by 1.6 days (Pâ=â0.002), and a hospital cost savings of $1492 per patient (Pâ=â0.01).CONCLUSIONS:
Alvimopan 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Piperidinas
/
Fármacos Gastrointestinais
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Redução de Custos
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Laparoscopia
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Cirurgia Colorretal
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Íleus
Tipo de estudo:
Etiology_studies
/
Guideline
/
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
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Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article