Document Detail


A statewide, community-based assessment of alvimopan's effect on surgical outcomes.
MedLine Citation:
PMID:  23388351     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Alvimopan was approved by the Food and Drug Administration in May 2008 and has been shown to accelerate gastrointestinal recovery after colectomy. Our independent study evaluated alvimopan as it is used in actual hospital practice in the state of Michigan. We hypothesized that alvimopan significantly decreases incidence of prolonged ileus and reduces length of stay (LOS) in patients who have undergone colectomy.
METHODS: We identified 4749 patients from the Michigan Surgical Quality Collaborative (N = 28 hospitals) database between August 2007 and December 2010 who underwent elective colectomy operations. A total of 528 patients received alvimopan both pre- and postoperatively. We first selected a control group of patients from hospitals that had never administered alvimopan (n = 1833) and used propensity matching to manage differences in patient demographics and clinical characteristics. To control for hospital and surgeon characteristics, we then performed a sensitivity analysis, using a separate group of historical control patients treated before May 2008 in hospitals that would later administer alvimopan (n = 270). The Fisher exact test was used to compare complication rates, and the Student t test was used to compare LOS.
RESULTS: Patients who received alvimopan had significantly lower incidence of prolonged ileus (2.3% vs 7.9%; P < 0.001) and a significantly shorter LOS (4.84 ± 4.54 vs 6.40 ± 4.45 days; P < 0.001) than control patients in hospitals that had never administered alvimopan. No differences were noted in these outcomes using sensitivity analysis.
CONCLUSION: This study suggests that the actual utilization of alvimopan leads to a reduction in prolonged ileus and LOS in patients who underwent colectomy. By accelerating postoperative recovery, alvimopan has the potential to benefit patients and health care systems by improving outcomes, ensuring patient comfort, and reducing cost.
Authors:
Calista M Harbaugh; Shaza N Al-Holou; Thomas S Bander; Joseph D Drews; Muazzum M Shah; Michael N Terjimanian; Shijie Cai; Darrell A Campbell; Michael J Englesbe
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  257     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-07     Completed Date:  2013-04-02     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  427-32     Citation Subset:  AIM; IM    
Affiliation:
Academic Surgeon Development Program, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
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MeSH Terms
Descriptor/Qualifier:
Colectomy / adverse effects*
Colonic Diseases / surgery
Dose-Response Relationship, Drug
Female
Gastrointestinal Agents
Humans
Ileus / epidemiology,  etiology,  prevention & control*
Incidence
Laparoscopy
Length of Stay / trends
Male
Michigan / epidemiology
Middle Aged
Piperidines / administration & dosage*
Postoperative Period
Recovery of Function / drug effects
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K08 DK0827508/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Gastrointestinal Agents; 0/Piperidines; 677C126AET/alvimopan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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