Alvimopan reduces length of stay and hospital costs after colorectal surgery

Last Updated: 2016-03-03

By Will Boggs MD

NEW YORK (Reuters Health) - Alvimopan, by hastening the recovery of bowel function, reduces length of stay and hospital costs for patients undergoing colorectal surgery, according to a retrospective study of registry data.

"Our study findings are consistent with previous randomized controlled trials as well as observational studies," Dr. Anne P. Ehlers, from University of Washington, Seattle, told Reuters Health by email. "The totality of evidence suggests that alvimopan is effective in routine practice, and that it is not associated with higher overall costs."

Alvimopan prevents opioid-induced postoperative ileus, and multiple randomized controlled trials have shown that it decreases the time to return of bowel function by five to 28 hours, depending on the dose.

Dr. Ehlers and colleagues in the Colorectal Writing Group for the SCOAP-CERTAIN collaborative evaluated the relationship between alvimopan use, length of stay (LOS), and hospital costs in a retrospective study of all 14,781 adult patients who underwent elective colorectal surgery from 2009 through 2013 at 51 participating hospitals in Washington.

Overall, 1,615 patients (11%) received alvimopan at 26 hospitals, and alvimopan use increased from 6% of patients in 2009 to 17% of patients in 2013, according to the February 5 online report in Journal of the American College of Surgeons.

After adjustment for various potential confounders, alvimopan use was associated with a shorter hospital LOS (by 0.9 day, p<0.01) and lower costs (by $636 per patient, p=0.02) compared with no alvimopan use.

In a planned post-hoc analysis that accounted for the lower complication rate in alvimopan-treated patients (8% versus 18% for other patients), alvimopan use was still associated with a significantly shorter LOS (by 0.7 day), but the overall hospital cost savings lost statistical significance.

In a propensity score matched analysis, LOS was about 33 hours shorter and hospital costs $1,720 lower in patients who received alvimopan.

"While it is not clear whether the lower costs directly resulted from the shorter hospital stay, it does suggest that alvimopan should not be withheld due to cost concerns," Dr. Ehlers said.

"We would like to emphasize the value of observational comparative-effectiveness studies, and how they can complement randomized studies by providing insights into practice patterns and outcomes outside the context of a trial," Dr. Ehlers added.

Dr. Kirk Ludwig, chief of Medical College of Wisconsin's division of colorectal surgery, Milwaukee, told Reuters Health by email, "I think that given the data from randomized controlled trials and the type of data presented here, one can make a strong argument for routine use of alvimopan for patients having elective colorectal surgery."

"In multiple settings, in multiple types of studies, its use seems to reduce LOS and hospital cost. At a minimum, physicians and hospitals should do the math with their patient populations and see how the fairly consistent one-day reduction in LOS and cost savings might impact their programs," he said.

"I think everyone should understand that postoperative ileus (POI) has a complex physiology and it is absolutely a factor in determining LOS after routine colorectal surgery," Dr. Ludwig explained. "There will be no magic bullet for resolving this postoperative gastrointestinal tract dysfunction. We should focus our efforts on making incremental changes in how we manage patients in the perioperative period to achieve better outcomes, minimize POI, reduce LOS, and lower cost. The current study, and the accumulated data, tells us that using alvimopan can help us in this effort."

The National Institute of Diabetes and Digestive and Kidney Diseases partially supported this research. Two coauthors reported disclosures.

SOURCE: http://bit.ly/1WWNe0K

J Am Coll Surg 2016.