Wesley Long Community Hospital Pharmacy, Moses Cone Health System, Greensboro, NC, USA.
Ann Pharmacother. 2010 Nov;44(11):1701-8. doi: 10.1345/aph.1P260. Epub 2010 Sep 21.
Alvimopan has received Food and Drug Administration approval to accelerate the time to upper and lower gastrointestinal recovery following partial large or small bowel resection with primary anastomosis.
To assess the efficacy, safety, and economic benefit of alvimopan in patients undergoing open or laparoscopic bowel resection in a community hospital system setting.
This 6-month, open-label, multi-hospital, prospective study combined with a retrospective chart review compared postoperative length of stay and postoperative ileus-related morbidity (nasogastric tube insertion, hospital readmission) for patients undergoing open or laparoscopic bowel resection who received alvimopan 12 mg (n = 108) versus historical control bowel resection patients (n = 91) who would have been eligible to receive alvimopan. Multivariate analysis assessed the effects of age and surgery type on postoperative length of stay. Additional-day hospital costs were estimated using ordinary least-squares regression to calculate costs based on length of stay in the control cohort.
Compared with historical controls, patients receiving alvimopan had a mean 1.8-day shorter postoperative length of stay (p = 0.01) and lower rates of nasogastric tube insertion (2% vs 15%, p < 0.001). Multivariate analysis revealed a statistically significant reduction in postoperative length of stay in the alvimopan group of approximately 1.2 days (p = 0.01), regardless of age or surgery type, with an even larger difference (3.2 days) observed in patients ≥70 years old. Mean cost savings associated with alvimopan use ranged from $531 (laparoscopic bowel resection) to $997 (open bowel resection) per patient.
Consistent with clinical trial data, alvimopan use resulted in an approximately 1 day shorter postoperative length of stay and was associated with substantial cost savings.
阿维莫潘已获得美国食品和药物管理局批准，可加速原发性吻合术的小肠或大肠部分切除术后上消化道和下消化道的恢复。
在社区医院系统中，评估阿维莫潘在接受开腹或腹腔镜肠切除术患者中的疗效、安全性和经济效益。
这项为期 6 个月、开放性、多医院、前瞻性研究结合回顾性图表审查，比较了接受阿维莫潘 12mg 治疗的开腹或腹腔镜肠切除术患者（n=108）与术后接受阿维莫潘治疗本应符合条件的历史对照肠切除术患者（n=91）的术后住院时间和术后肠梗阻相关发病率（鼻胃管插入、医院再入院）。多变量分析评估了年龄和手术类型对术后住院时间的影响。使用普通最小二乘法回归估计额外住院日的医院成本，根据对照队列的住院时间计算成本。
与历史对照相比，接受阿维莫潘治疗的患者术后住院时间平均缩短 1.8 天（p=0.01），且胃管插入率更低（2% vs. 15%，p<0.001）。多变量分析显示，阿维莫潘组术后住院时间有统计学意义的显著缩短，约为 1.2 天（p=0.01），与年龄或手术类型无关，≥70 岁患者的差异更大（3.2 天）。与使用阿维莫潘相关的平均成本节省范围为每位患者 531 美元（腹腔镜肠切除术）至 997 美元（开腹肠切除术）。
与临床试验数据一致，阿维莫潘的使用可使术后住院时间缩短约 1 天，并可节省大量成本。
