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Alvimopan is associated with favorable outcomes in open and minimally invasive colorectal surgery: a regional database analysis

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Abstract

Background

Alvimopan is a µ-opioid receptor antagonist associated with shorter time to gastrointestinal recovery in patients having open colorectal surgery. Data demonstrating the benefit of perioperative alvimopan for the minimally invasive surgical approach are inconsistent. The aim of this study is to determine colorectal surgery groups that benefit from perioperative alvimopan.

Methods

This is a retrospective cohort analysis of colorectal surgery patients who had, and patients who did not have, perioperative alvimopan in the Michigan Surgical Quality Collaborative regional risk-adjusted database from 2018 through 2021. Main outcome measures were postoperative length of hospital stay, time to return of bowel function, and postoperative ileus.

Results

There were 10,010 patients (30.3% open, 40.5% laparoscopic, 12.7% hand-assist laparoscopic, 43.5% robotic) who met inclusion criteria—4919 received alvimopan in the perioperative period and 5091 did not. When compared to those not receiving alvimopan, unadjusted outcomes showed that the alvimopan group had significantly shorter postoperative length of stay (4.75 days vs 5.5 days, p < 0.001), shorter time to return of bowel function (1.61 days vs 2.01 days, p < 0.001) and less postoperative ileus (5.45% vs 7.94%, p < 0.001). After adjustment, regression models confirmed that alvimopan was associated with an 9.6% reduction in hospital length of stay (p < 0.001), a 14.9% shorter time to return of bowel function (p < 0.001), and a 42.1% reduction in postoperative ileus (p < 0.001). Subgroup analysis showed significant benefit of alvimopan for all three outcomes in patients having the minimally invasive approach.

Conclusions

Alvimopan is associated with shorter hospital length of stay, shorter time to return of bowel function, and decreased postoperative ileus when administered to patients undergoing colorectal surgery. Benefit is not limited to the open approach and includes minimally invasive laparoscopic and robotic colorectal procedures.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Pharmacy, St Joseph Mercy Hospital, Ann Arbor, MI, USA

    Patricia Kaarto & Kara Brockhaus

  2. Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA

    Kristen M. Westfall & Robert K. Cleary

  3. Michigan State University School of Medicine, East Lansing, USA

    Amanda L. Paulus

  4. Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ypsilanti, MI, USA

    Jeremy Albright

  5. St Joseph Mercy Hospital, Ann Arbor, MI, USA

    Carole Ramm

Authors
  1. Patricia Kaarto
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  2. Kristen M. Westfall
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  3. Kara Brockhaus
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  4. Amanda L. Paulus
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  5. Jeremy Albright
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  6. Carole Ramm
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  7. Robert K. Cleary
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Corresponding author

Correspondence to Robert K. Cleary.

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Disclosures

Robert K. Cleary MD reports personal fees from Intuitive Surgical, outside the submitted work. Patricia Kaarto, Kristen M. Westfall, Kara Brockhaus, Amanda L. Paulus, Jeremy Albright, and Carole Ramm have no conflict of interests or financial ties to disclose.

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Kaarto, P., Westfall, K.M., Brockhaus, K. et al. Alvimopan is associated with favorable outcomes in open and minimally invasive colorectal surgery: a regional database analysis. Surg Endosc 37, 6097–6106 (2023). https://doi.org/10.1007/s00464-023-10098-7

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  • DOI: https://doi.org/10.1007/s00464-023-10098-7

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