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Cost and efficacy examination of alvimopan for the prevention of postoperative ileus
  1. Zoltan H Nemeth1,2,
  2. Dorian A Bogdanovski1,
  3. Samantha R Paglinco1,
  4. Patricia Barratt-Stopper1,
  5. Rolando H Rolandelli1
  1. 1Department of Surgery, Morristown Medical Center, Morristown, New Jersey, USA
  2. 2Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr Zoltan H Nemeth, Department of Surgery, Morristown Medical Center, 100 Madison Ave #88, Morristown, NJ 07960, USA; Zoltan.Nemeth{at}atlantichealth.org

Abstract

Opioid analgesics exacerbate ileus through peripheral μ-opioid receptor action. Alvimopan, a μ-opioid receptor antagonist, has been proposed to alleviate postoperative ileus, leading to decreased time to return of gastrointestinal function and hospital discharge. As opioid-induced motility issues are only one factor affecting postoperative ileus, continued examination of the cost of the use and efficacy of the drug is needed. Data for this study were collected retrospectively from the charts of 55 patients who received an anastomosis and were given alvimopan at Morristown Medical Center between 2010 and 2013 as well as from 58 appropriately matched controls. The billing record and chart for each patient was examined, and information on total hospital charges, age, sex, body mas index, primary diagnosis, procedure type, length of stay (days), time to return of bowel function (hours), and outcomes were recorded for analysis. No difference between patients given alvimopan and controls was observed for the length of hospital stay (4.6 vs 4.8 days) or for time to return of bowel function (68.5 vs 67.3 hours). Total hospital charges were higher for treated patients (p=0.0080), averaging $48 705.15 and $41 068.80, respectively. Alvimopan was not associated with improved clinical outcome but was associated with an increase in hospital charges within this population.

  • Colon
  • Digestive System Surgical Procedures
  • Surgical Stapling
  • Pain
  • Clinical Research

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Footnotes

  • Contributors ZHN was involved in the design of the study and writing of the manuscript. DAB has been involved in data analysis, writing, and critical revision of the manuscript. SRP has been involved in data collection, and data analysis, and writing of the manuscript. PB-S has been involved in data analysis, and critical revision of the manuscript. RHR has been involved in the design of the study, data collection, and critical revision of the manuscript.

  • Funding This research study was funded by the Department of Surgery, Morristown Medical Center, Morristown, New Jersey.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Atlantic Health Internal Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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