Erica Pettke1, Abhinit Shah1, Vesna Cekic1, Daniel Feingold2, Tracey Arnell2, Nipa Gandhi1, Carl Winkler, MD1, Richard Whelan1. 1Mount Sinai West, 2Columbia University
Introduction: Alvimopan (Alvim) is a peripherally acting µ-opioid receptor antagonist used to accelerate gastrointestinal functional recovery postoperatively (postop) after bowel resection. The purpose of this retrospective study was to compare the time to first flatus and bowel movement (BM) as well as length of stay (LOS) following elective minimally invasive colorectal resection (CRR) in a group of patients (pts) who received alvimopan perioperatively (periop) vs a group that did not get this agent.
Methods: A data review from 2000-2015 from 2 IRB approved databases was carried out. Operative, hospital and office charts were reviewed. Routine use of Alvim for elective CRR cases was stared in 2013. Besides GI data, preoperative comorbidities and 30 day postop complication rates were assessed. The results with periop Alvim were compared to a no-Alvim group. The Students T and Chi-Square tests were used.
Results: A total of 902 pts underwent elective CRR. Alvim was administered periop to 262 pts (29%). The breakdown of indications between groups were similar. Alvim pts were younger (60.4 vs. 63.8 years old, p = 0.002) and, as regards comorbidities, less likely to have heart disease (CAD 4.1% vs 13.9%, other heart disease 13.2% vs 19.5%) but were otherwise similar. The rate of laparoscopic-assisted (Alvim, 80.9%; No Alvim, 68%) and hand assisted or hybrid operations (Alvim, 19.1%; No Alvim, 32%) were similar. Alvim pts had significantly earlier return of flatus (2.4 vs 2.9 days) and first BM (2.6 vs 3.5, p<0.001 for both) than the No Alvim group. There was also a trend toward a shorter LOS (6.1 vs 6.7 days, p=0.05) for the Alvim group. Overall complication rates were similar, however, Alvim pts had lower rates of post-operative ileus (5.3% vs 14.1%, p < 0.0002), sSSI’s (5.8 vs 10%, p=0.04), and blood transfusion (7.1 vs 13.0%, p=0.01) than the No Alvim group.
Conclusion: The two groups compared were largely similar (most co-morbidities, indications, CRR type) with the differences in age and cardiac issues noted. The impact of the higher rates of sSSI’s, blood transfusion, and MI in the no Alvim group on GI function is unclear. Pts who received Alvim periop had an accelerated return of bowel function, decreased postoperative ileus and shorter length of stay. These results suggest that Alvim is effective in reducing the postoperative ileus but further study is warranted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87549
Program Number: P281
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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