1633 THE OPIOID RECEPTOR ANTAGONIST ALVIMOPAN MINIMIZES POSTOPERATIVE ILEUS FOLLOWING RADICAL CYSTECTOMY: AN UPDATE

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive (II)1 Apr 20131633 THE OPIOID RECEPTOR ANTAGONIST ALVIMOPAN MINIMIZES POSTOPERATIVE ILEUS FOLLOWING RADICAL CYSTECTOMY: AN UPDATE Joel Bigley, Jamie Uy, Jodi Maranchie, Jeffrey Gingrich, Benjamin Davies, and Ronald Hrebinko Joel BigleyJoel Bigley Pittsburgh, PA More articles by this author , Jamie UyJamie Uy Pittsburgh, PA More articles by this author , Jodi MaranchieJodi Maranchie Pittsburgh, PA More articles by this author , Jeffrey GingrichJeffrey Gingrich Pittsburgh, PA More articles by this author , Benjamin DaviesBenjamin Davies Pittsburgh, PA More articles by this author , and Ronald HrebinkoRonald Hrebinko Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3183AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-operative ileus contributes significantly to the morbidity associated with radical cystectomy and urinary diversion. Alvimopan is a peripherally acting μ-opioid receptor antagonist approved to accelerate gastrointestinal recovery following bowel resection. We have previously reported that alvimopan decreases the time to return of bowel function and hospital length of stay in a cohort of 24 patients undergoing radical cystectomy. We now present our updated experience. METHODS Seventy-three additional patients underwent radical cystectomy and received perioperative alvimopan, increasing the treatment cohort size to 97 patients. Forty-eight patients who had undergone radical cystectomy and not received alvimopan were used as a control group, as described previously. Primary outcomes of interest included time to GI-2 (toleration of solid food and first bowel movement) and GI-3 (toleration of solid food and first flatus or bowel movement) recovery and to hospital discharge. Secondary outcomes included opioid consumption and readmission within 30 days for postoperative ileus-related morbidities. To minimize the effects of outliers, primary outcomes were censored at 10 days. Categorical and linear variables were compared using Fisher's exact and Mann-Whitney U tests, respectively. RESULTS There was no significant difference in median patient age, type of urinary diversion, operative time, or opioid consumption between groups. Alvimopan significantly decreased time to return of bowel function (GI-2: 111.4±39.4 vs. 119.6±49.9 hr, p<0.01; GI-3: 98.5±39.9 vs. 119.6±49.7 hr, p<0.01). Hospital length of stay was significantly shorter in patients treated with alvimopan (5.6±1.6 vs. 6.8±1.9 d, p<0.01). The 30-day readmission rate for vomiting, adynamic ileus, or partial small bowel obstruction in patients receiving alvimopan was 2.1% compared to 12.5% in the control group (p<0.05). Addition of the updated treatment cohort decreased the magnitude of response in all primary outcomes when compared with previous findings. However, there were no significant differences between the original and updated treatment cohorts in primary outcomes. CONCLUSIONS Alvimopan use shortened hospital length of stay and decreased time to return of bowel function by approximately one day in a large cohort of patients undergoing radical cystectomy. Alvimopan also decreased hospital readmissions due to postoperative ileus-related morbidities. These results further support the clinical benefit of alvimopan in patients undergoing radical cystectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e672 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joel Bigley Pittsburgh, PA More articles by this author Jamie Uy Pittsburgh, PA More articles by this author Jodi Maranchie Pittsburgh, PA More articles by this author Jeffrey Gingrich Pittsburgh, PA More articles by this author Benjamin Davies Pittsburgh, PA More articles by this author Ronald Hrebinko Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...