Department of Pharmacy, St Joseph Mercy Hospital, Ann Arbor, MI, USA.
Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA.
Surg Endosc. 2023 Aug;37(8):6097-6106. doi: 10.1007/s00464-023-10098-7. Epub 2023 May 2.
Alvimopan is a µ-opioid receptor antagonist associated with shorter time to gastrointestinal recovery in patients having open colorectal surgery. Data demonstrating the benefit of perioperative alvimopan for the minimally invasive surgical approach are inconsistent. The aim of this study is to determine colorectal surgery groups that benefit from perioperative alvimopan.
This is a retrospective cohort analysis of colorectal surgery patients who had, and patients who did not have, perioperative alvimopan in the Michigan Surgical Quality Collaborative regional risk-adjusted database from 2018 through 2021. Main outcome measures were postoperative length of hospital stay, time to return of bowel function, and postoperative ileus.
There were 10,010 patients (30.3% open, 40.5% laparoscopic, 12.7% hand-assist laparoscopic, 43.5% robotic) who met inclusion criteria-4919 received alvimopan in the perioperative period and 5091 did not. When compared to those not receiving alvimopan, unadjusted outcomes showed that the alvimopan group had significantly shorter postoperative length of stay (4.75 days vs 5.5 days, p < 0.001), shorter time to return of bowel function (1.61 days vs 2.01 days, p < 0.001) and less postoperative ileus (5.45% vs 7.94%, p < 0.001). After adjustment, regression models confirmed that alvimopan was associated with an 9.6% reduction in hospital length of stay (p < 0.001), a 14.9% shorter time to return of bowel function (p < 0.001), and a 42.1% reduction in postoperative ileus (p < 0.001). Subgroup analysis showed significant benefit of alvimopan for all three outcomes in patients having the minimally invasive approach.
Alvimopan is associated with shorter hospital length of stay, shorter time to return of bowel function, and decreased postoperative ileus when administered to patients undergoing colorectal surgery. Benefit is not limited to the open approach and includes minimally invasive laparoscopic and robotic colorectal procedures.
阿片受体拮抗剂奥曲肽与接受开腹结直肠手术的患者胃肠道恢复时间更短相关。围手术期使用奥曲肽对微创手术方法有益的数据不一致。本研究的目的是确定接受围手术期奥曲肽治疗的结直肠手术患者群体。
这是对 2018 年至 2021 年密歇根外科质量协作区域风险调整数据库中接受和未接受围手术期奥曲肽治疗的结直肠手术患者的回顾性队列分析。主要观察指标为术后住院时间、恢复肠蠕动时间和术后肠梗阻。
共有 10010 名患者（30.3%为开放性手术，40.5%为腹腔镜手术，12.7%为手助腹腔镜手术，43.5%为机器人手术）符合纳入标准，其中 4919 名患者在围手术期接受了奥曲肽治疗，5091 名患者未接受奥曲肽治疗。与未接受奥曲肽治疗的患者相比，未调整的结果显示，奥曲肽组的术后住院时间明显缩短（4.75 天 vs 5.5 天，p<0.001），肠蠕动恢复时间缩短（1.61 天 vs 2.01 天，p<0.001），术后肠梗阻发生率降低（5.45% vs 7.94%，p<0.001）。调整后，回归模型证实奥曲肽与住院时间缩短 9.6%（p<0.001）、肠蠕动恢复时间缩短 14.9%（p<0.001）和术后肠梗阻发生率降低 42.1%（p<0.001）相关。亚组分析显示，奥曲肽对所有三种微创方法的患者均有显著获益。
奥曲肽可缩短结直肠手术患者的住院时间、肠蠕动恢复时间和术后肠梗阻的发生。其益处不仅限于开放性手术，还包括微创腹腔镜和机器人结直肠手术。
