1160 ALVIMOPAN PROVIDES RAPID GASTROINTESTINAL RECOVERY WITHOUT NASOGASTRIC TUBE DECOMPRESSION AFTER RADICAL CYSTECTOMY AND URINARY DIVERSION

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121160 ALVIMOPAN PROVIDES RAPID GASTROINTESTINAL RECOVERY WITHOUT NASOGASTRIC TUBE DECOMPRESSION AFTER RADICAL CYSTECTOMY AND URINARY DIVERSION Anup Vora, Andrew Harbin, Robert Rayson, Keit Christiansen, Jonathan Hwang, Reza Ghasemian, and Mohan Verghese Anup VoraAnup Vora Washington, DC More articles by this author , Andrew HarbinAndrew Harbin Washington, DC More articles by this author , Robert RaysonRobert Rayson Washington, DC More articles by this author , Keit ChristiansenKeit Christiansen Washington, DC More articles by this author , Jonathan HwangJonathan Hwang Washington, DC More articles by this author , Reza GhasemianReza Ghasemian Washington, DC More articles by this author , and Mohan VergheseMohan Verghese Washington, DC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1384AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy is associated with significant morbidity, with rates of gastrointestinal complications as high as 30%. Alvimopan is a mu opioid receptor antagonist that has been shown in randomized-control trials to accelerate gastrointestinal recovery in patients undergoing bowel resection with primary anastamosis. We report our experience with gastrointestinal recovery for patients undergoing cystectomy with urinary diversion treated with alvimopan. METHODS Between 1/2008 and 9/2011, 50 consecutive patients underwent radical cystectomy with urinary diversion at our institution. The first 27 patients in our study did not receive alvimopan preoperatively and had selective removal of postoperative nasogastric decompression. The latter 23 patients received perioperative alvimopan and were without any postoperative nasogastric tube. Return of bowel function, initiation of diet, length of hospital stay and gastrointestinal complications were evaluated. RESULTS Times to first flatus (3.1 vs 5.6 days, p<0.001, 95% CI 1.57 - 3.29) and bowel movement (3.8 vs 6.0 days, p<0.001, 95% CI 1.31 - 3.09) were significantly shorter in those patients who received alvimopan. Additionally, the initiation of clear liquid diet(4.1 vs 6.3 days, p<0.001, 95% CI 1.06 - 3.10), regular diet (5.7 vs 7.3 days, p=0.023, 95% CI 0.53 - 2.68), and hospital discharge (7.4 vs 9.5 days, p=0.04, 95% CI 0.03 - 4.21) were accelerated in the alvimopan cohort. There were no incidences of prolonged ileus in patients who received perioperative alvimopan (0% vs 25.9%, p=0.012). CONCLUSIONS In our experience, the use of alvimopan perioperatively significantly accelerates the rate of gastrointestinal recovery and hospital discharge, eliminates the need for nasogastric tube decompression, and reduces the incidence of post-operative ileus in patients following radical cystectomy and urinary diversion. Alvimopan Control p-value Age 68.4 69.6 0.669 % Male 65.2 81.4 0.198 % Smoking History 86.9 88.9 0.838 Body Mass Index 28.1 29.8 0.645 % Epidural PCA 26.1 25.9 0.784 % Ileal Conduit Urinary Diversion 86.9 92.6 0.318 Perioperative Patient Outcomes. All lengths are in days. Alvimopan Control p value Duration of NGT 0 4.9 <0.001 Time to Flatus 3.1 5.6 <0.001 Time to First Bowel Movement 3.8 6.0 <0.001 Initiation of Sips 3.3 4.8 0.014 Initiation of Clear Liquids 4.1 6.3 <0.001 Initiation of Regular Diet 5.7 7.3 0.024 Length of Hospital Stay 7.4 9.5 0.047 % Requiring TPN 0 22.2 0.015 Perioperative Patient Outcomes. All lengths are in days. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e470 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anup Vora Washington, DC More articles by this author Andrew Harbin Washington, DC More articles by this author Robert Rayson Washington, DC More articles by this author Keit Christiansen Washington, DC More articles by this author Jonathan Hwang Washington, DC More articles by this author Reza Ghasemian Washington, DC More articles by this author Mohan Verghese Washington, DC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...