Background Randomized trials have found that alvimopan hastens return of bowel function and reduces length of stay (LOS) by 1 day among patients undergoing colorectal surgery. However, its effectiveness in routine clinical practice and its impact on hospital costs remain uncertain. Study Design We performed a retrospective cohort study of patients undergoing elective colorectal surgery in Washington state (2009 to 2013) using data from a clinical registry (Surgical Care and Outcomes Assessment Program) linked to a statewide hospital discharge database (Comprehensive Hospital Abstract Reporting System). We used generalized estimating equations to evaluate the relationship between alvimopan and outcomes, and adjusted for patient, operative, and management characteristics. Hospital charges were converted to costs using hospital-specific charge to cost ratios, and were adjusted for inflation to 2013 US dollars. Results Among 14,781 patients undergoing elective colorectal surgery at 51 hospitals, 1,615 (11%) received alvimopan. Patients who received alvimopan had a LOS that was 1.8 days shorter (p < 0.01) and costs that were $2,017 lower (p < 0.01) compared with those who did not receive alvimopan. After adjustment, LOS was 0.9 days shorter (p < 0.01), and hospital costs were $636 lower (p = 0.02) among those receiving alvimopan compared with those who did not. Conclusions When used in routine clinical practice, alvimopan was associated with a shorter LOS and limited but significant hospital cost savings. Both efficacy and effectiveness data support the use of alvimopan in routine clinical practice, and its use could be measured as a marker of higher quality care.
Bibliographical noteFunding Information:
Support: Dr Ehlers was supported by a training grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number T32DK070555. Dr Farjah received support as a Cancer Research Network Scholar (CRN4: Cancer Research Resources & Collaboration in Integrated Health Care Systems, grant number U24 CA171524).
Disclaimer: The Surgical Care and Outcomes Assessment Program is a program of the Foundation for HealthCare Quality. The Comparative Effectiveness Research Translation Network (CERTAIN) is a program of the University of Washington that provided research and analytic support for this publication and was supported by funding from the AHRQ under award number R01HS020025. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the Cancer Research Network, the Foundation for HealthCare Quality, or the AHRQ.
© 2016 American College of Surgeons.
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