Department of General Surgery, Royal Gwent Hospital, Newport, UK.
Department of General Surgery, University Hospital of Wales, Cardiff, UK.
Am Surg. 2024 Dec;90(12):3272-3283. doi: 10.1177/00031348241265149. Epub 2024 Jul 20.
The aim is to investigate the effect of alvimopan on postoperative ileus and length of hospital stay in patients undergoing bowel resection.
The PRISMA statement standards were followed to conduct a systematic review and meta-analysis. The available literature was searched to identify all studies comparing alvimopan with no alvimopan in patients undergoing bowel resection. Postoperative ileus and length of hospital stay were the primary outcomes, and time to first bowel motion was the secondary outcome. Random-effects modeling was applied for analyses.
Analysis of 94 833 patients from 26 studies showed that alvimopan was associated with lower risk of postoperative ileus (OR: .57, 95% CI .48 to .67, <.00001; high GRADE certainty), shorter length of hospital stay (MD: -1.08 day, 95% CI -1.36 to -.81, < .00001; moderate GRADE certainty), and shorter time to first bowel motion (MD: -.43 day, 95% CI -.58 to -.28, < .00001; moderate GRADE certainty). Separate analyses of randomized controlled trials and observational studies showed similar findings. Subgroup analyses suggested consistent findings in patients undergoing elective bowel resection, emergency bowel resection, and open surgery; however, alvimopan did not improve the outcomes in patients undergoing minimally invasive surgery.
Robust evidence supports the routine use of alvimopan in patients undergoing open bowel resection as indicated by lower risk of postoperative ileus and shorter length of hospital stay. We support incorporation of alvimopan into enhanced recovery after surgery programs for the procedures involving open bowel resection. The role of alvimopan in minimally invasive bowel resection needs more research.
旨在研究阿维莫潘对肠切除术患者术后肠梗阻和住院时间的影响。
按照 PRISMA 声明标准进行系统评价和荟萃分析。检索可用文献，以确定比较阿维莫潘和未用阿维莫潘的肠切除术患者的所有研究。术后肠梗阻和住院时间是主要结局，首次排便时间是次要结局。采用随机效应模型进行分析。
对 26 项研究的 94833 例患者进行分析表明，阿维莫潘与术后肠梗阻风险降低相关（OR：0.57，95%CI：0.48 至 0.67，<0.00001；高 GRADE 确定性），住院时间更短（MD：-1.08 天，95%CI：-1.36 至-0.81，<0.00001；中 GRADE 确定性），首次排便时间更短（MD：-0.43 天，95%CI：-0.58 至-0.28，<0.00001；中 GRADE 确定性）。随机对照试验和观察性研究的单独分析显示了类似的结果。亚组分析表明，在择期肠切除术、急诊肠切除术和开放性手术患者中发现了一致的结果；然而，阿维莫潘并未改善微创手术患者的结局。
强有力的证据支持在开放性肠切除术中常规使用阿维莫潘，以降低术后肠梗阻和缩短住院时间的风险。我们支持将阿维莫潘纳入涉及开放性肠切除术的术后加速康复方案中。阿维莫潘在微创肠切除术中的作用需要更多的研究。
