Adam Mohamed Abdelgadir, Lee Lacey M, Kim Jina, Shenoi Mithun, Mallipeddi Mohan, Aziz Hamza, Stinnett Sandra, Sun Zhifei, Mantyh Christopher R, Thacker Julie K M
*Department of Surgery, Duke University Medical Center, Durham, NC†Department of Pharmacy, Duke University Medical Center, Durham, NC‡Department of Biostatistics, Duke University, Durham, NC.
Ann Surg. 2016 Jul;264(1):141-6. doi: 10.1097/SLA.0000000000001428.
To examine the impact of alvimopan on outcomes and costs in a rigorous enhanced recovery colorectal surgery protocol.
Postoperative ileus remains a major source of morbidity and costs in colorectal surgery. Alvimopan has been shown to reduce incidence of postoperative ileus in enhanced recovery colorectal surgery; however, data are equivocal regarding its benefit in reducing length of stay and costs.
Patients undergoing major elective enhanced recovery colorectal surgery were identified from a prospectively-collected database (2010-2013). Multivariable analyses were employed to compare outcomes and hospital costs among patients who had alvimopan versus no alvimopan by adjusting for demographic, clinical, and treatment characteristics.
A total of 660 patients were included; 197 patients received alvimopan and 463 patients had no alvimopan. In unadjusted analysis, the alvimopan group had a faster return of bowel function, shorter length of stay, and lower rates of ileus, Foley re-insertion, and urinary tract infection (all P < 0.01). After adjustment, alvimopan was associated with a faster return of bowel function by 0.6 day (P = 0.0006), and lower incidence of postoperative ileus (odds ratio 0.23, P = 0.0002). With adjustment, alvimopan was associated with a shorter length of stay by 1.6 days (P = 0.002), and a hospital cost savings of $1492 per patient (P = 0.01).
Alvimopan administration as an element of enhanced recovery colorectal surgery is associated with faster return of bowel function, lower incidence of postoperative ileus, shorter hospitalization, and a significant cost savings. These results suggest that alvimopan is cost-effective in the setting of enhanced recovery colorectal surgery protocols, and should therefore be considered in these programs.
在严格的结直肠癌手术强化康复方案中，研究阿维莫潘对治疗结果和成本的影响。
术后肠梗阻仍然是结直肠癌手术中发病和成本的主要来源。在结直肠癌手术强化康复中，阿维莫潘已被证明可降低术后肠梗阻的发生率；然而，关于其在缩短住院时间和降低成本方面的益处，数据并不明确。
从一个前瞻性收集的数据库（2010 - 2013年）中识别出接受大型择期结直肠癌手术强化康复的患者。通过对人口统计学、临床和治疗特征进行调整，采用多变量分析比较接受阿维莫潘治疗的患者与未接受阿维莫潘治疗的患者的治疗结果和医院成本。
共纳入660例患者；197例患者接受了阿维莫潘治疗，463例患者未接受阿维莫潘治疗。在未调整分析中，阿维莫潘组肠道功能恢复更快、住院时间更短，肠梗阻、重新插入导尿管和尿路感染的发生率更低（所有P<0.01）。调整后，阿维莫潘与肠道功能恢复加快0.6天相关（P = 0.0006），术后肠梗阻发生率更低（优势比0.23，P = 0.0002）。调整后，阿维莫潘与住院时间缩短1.6天相关（P = 0.002），每位患者节省医院成本1492美元（P = 0.01）。
在结直肠癌手术强化康复方案中使用阿维莫潘与肠道功能恢复更快、术后肠梗阻发生率更低、住院时间缩短以及显著的成本节约相关。这些结果表明，在结直肠癌手术强化康复方案中，阿维莫潘具有成本效益，因此应在这些方案中予以考虑。
