Alvimopan in the Setting of Colorectal Resection with an Ostomy: to Use or Not to Use?

Yuxiang Wen, BM, Murad A Jabir, MD, Michael Keating, BA, Alison R Althans, BA, Justin T Brady, MD, Bradley J Champagne, MD, Conor P Delaney, MD, MCh, PhD, Scott R Steele, MD. University Hospitals Case Medical Center/Case Western Reserve University

Introduction: Postoperative ileus (POI) is a major cause of morbidity, increasing length of stay (LOS) and hospital costs after colorectal surgery.  Many efforts have been made to decrease the rate of POI. Alvimopan is a mu opioid antagonist approved to accelerate upper and lower gastrointestinal function after bowel resection. We hypothesized that alvimopan would reduce LOS in patients undergoing colorectal resection with stoma.

Methods and Procedures: Over an 8 year period (2006-2014), 725 patients underwent colorectal resection for both benign and malignant disease with stoma creation at a single academic medical center. The 58 patients who received alvimopan were matched to 116 non-alvimopan patients based on age, diagnosis and procedure performed. We compared overall LOS, incidence of POI, and other postoperative complications.

Results: There were 18 laparoscopic and 40 open resections in the alvimopan group and 23 laparoscopic and 93 open resections in non-alvimopan group.  39 patients underwent resection for malignant disease and 19 patients underwent resection for benign disease in the alvimopan group. Of the patients who did not receive alvimopan, 87 patients underwent resection for malignant disease and 29 patients underwent resection for benign disease. Mortality was similar at 0 vs. 1.7%. There was no significant difference in median LOS (alvimopan 5.89 vs. control 6.69 days, P=0.15). Reoperation rates (5.2% vs. 5.2%, p>0.05) and complication rates (43.1% vs. 52.6%, p=0.238) were comparable. Readmission rate within 30 days was similar between groups (alvimopan 22.4% vs. control 20.7%, P=0.793).

Conclusions: The use of alvimopan in patients undergoing colorectal resection with stoma is not associated with a shorter LOS, or decreased readmission or complication rates. Pending further larger clinical trials, alvimopan should be reserved for patients undergoing primary anastomosis without diversion.

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