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Alvimopan: A cost-effective tool to decrease cystectomy length of stay.

Manger JP, Nelson M, Blanchard S, Helo S, Conaway M, Krupski TL - Cent European J Urol (2014)

Bottom Line: Patients who received alvimopan experienced a shorter length of stay (LOS) versus those in who did not receive alvimopan (10.5 vs. 8.6 days, p = 0.005, 95% CI 0.6-3.3).Additionally, institution of routine perioperative alvimopan has reduced costs by $7,062 per admission (20% reduction).This demonstrates a real world application of alvimopan at a moderate volume center.

View Article: PubMed Central - PubMed

Affiliation: University of Virginia, Department of Urology, Charlottesville, USA.

ABSTRACT

Introduction: We sought to evaluate the cost effectiveness of perioperative use of alvimopan in cystectomy and urinary diversion. A recent randomized controlled trial demonstrated the efficacy of alvimopan in reducing postoperative ileus and length of stay in cystectomy; however, a major limitation was the exclusion of epidural analgesia.

Materials and methods: Eighty-six cystectomy and urinary diversion procedures performed by seven surgeons were analyzed between January 2008 and April 2012. The first 50 patients did not receive alvimopan perioperatively, while the subsequent 36 received a single dose of 12 mg preoperatively and then 12 mg every 12 hours for 15 doses or until discharge.

Results: The groups were equal with respect to age, gender, indication, surgeon, and type of diversion. Patients who received alvimopan experienced a shorter length of stay (LOS) versus those in who did not receive alvimopan (10.5 vs. 8.6 days, p = 0.005, 95% CI 0.6-3.3). Readmission for ileus was low in both alvimopan and control groups (0% and 4.4%, respectively). Costs were significantly lower in the alvimopan group than the control groups (2012 USD 32,443 vs. 40,604 p <0.001). This difference stood up to multivariate analysis with a $7,062 difference in hospital stay.

Conclusions: Use of alvimopan in the routine perioperative care of our cystectomy and urinary diversion patients has decreased LOS by 1.9 days. Additionally, institution of routine perioperative alvimopan has reduced costs by $7,062 per admission (20% reduction). This demonstrates a real world application of alvimopan at a moderate volume center.

No MeSH data available.


Related in: MedlinePlus

Quantile LOS.
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Figure 0001: Quantile LOS.

Mentions: With regards to outcomes, readmission for ileus (4.4% pre–alvimopan vs. 0% alvimopan, p = 0.26) was similar in the groups. Utilization of total parenteral nutrition was higher in the pre–alvimopan group (38.8% pre–alvimopan 20.6% vs. alvimopan, p = 0.010). Time to clear liquid diet was 5.3 and 3.7 days in the pre–alvimopan and alvimopan groups, respectively (p = 0.058). Time to regular diet was significantly longer in the pre–alvimopan cohort at 7.1 days compared to 4.8 days in the treatment group (p = 0.020). Length of stay was reduced by 1.9 days (18% reduction in LOS) in the alvimopan group (10.5 vs. 8.6 days, p = 0.005, 95% CI 0.6–3.3) (see Table 2). While most patients stayed 8 to 10 days, the alvimopan group had one third of patients leaving at 7 days or earlier, while the pre–alvimopan group LOS was 11 days or greater in 40% of patients (Figure 1). No dose response effect was noted when comparing the number of doses administered versus LOS beyond a single dose. On multivariate analysis taking into account robotic technique, OR time, EBL, ICU disposition, epidural use, and patient controlled analgesia, there was a 16% reduction in LOS (p = 0.048, 95% CI 0.1–29%). Importantly, the robotic technique did not affect LOS and thus could not account for the difference of LOS between the pre–and post–alvimopan cohorts. Using propensity scoring Poisson regression to take into account additional variables, the magnitude of LOS reduction was again 16% (95% CI 0.0–30%, p = 0.050).


Alvimopan: A cost-effective tool to decrease cystectomy length of stay.

Manger JP, Nelson M, Blanchard S, Helo S, Conaway M, Krupski TL - Cent European J Urol (2014)

Quantile LOS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310883&req=5

Figure 0001: Quantile LOS.
Mentions: With regards to outcomes, readmission for ileus (4.4% pre–alvimopan vs. 0% alvimopan, p = 0.26) was similar in the groups. Utilization of total parenteral nutrition was higher in the pre–alvimopan group (38.8% pre–alvimopan 20.6% vs. alvimopan, p = 0.010). Time to clear liquid diet was 5.3 and 3.7 days in the pre–alvimopan and alvimopan groups, respectively (p = 0.058). Time to regular diet was significantly longer in the pre–alvimopan cohort at 7.1 days compared to 4.8 days in the treatment group (p = 0.020). Length of stay was reduced by 1.9 days (18% reduction in LOS) in the alvimopan group (10.5 vs. 8.6 days, p = 0.005, 95% CI 0.6–3.3) (see Table 2). While most patients stayed 8 to 10 days, the alvimopan group had one third of patients leaving at 7 days or earlier, while the pre–alvimopan group LOS was 11 days or greater in 40% of patients (Figure 1). No dose response effect was noted when comparing the number of doses administered versus LOS beyond a single dose. On multivariate analysis taking into account robotic technique, OR time, EBL, ICU disposition, epidural use, and patient controlled analgesia, there was a 16% reduction in LOS (p = 0.048, 95% CI 0.1–29%). Importantly, the robotic technique did not affect LOS and thus could not account for the difference of LOS between the pre–and post–alvimopan cohorts. Using propensity scoring Poisson regression to take into account additional variables, the magnitude of LOS reduction was again 16% (95% CI 0.0–30%, p = 0.050).

Bottom Line: Patients who received alvimopan experienced a shorter length of stay (LOS) versus those in who did not receive alvimopan (10.5 vs. 8.6 days, p = 0.005, 95% CI 0.6-3.3).Additionally, institution of routine perioperative alvimopan has reduced costs by $7,062 per admission (20% reduction).This demonstrates a real world application of alvimopan at a moderate volume center.

View Article: PubMed Central - PubMed

Affiliation: University of Virginia, Department of Urology, Charlottesville, USA.

ABSTRACT

Introduction: We sought to evaluate the cost effectiveness of perioperative use of alvimopan in cystectomy and urinary diversion. A recent randomized controlled trial demonstrated the efficacy of alvimopan in reducing postoperative ileus and length of stay in cystectomy; however, a major limitation was the exclusion of epidural analgesia.

Materials and methods: Eighty-six cystectomy and urinary diversion procedures performed by seven surgeons were analyzed between January 2008 and April 2012. The first 50 patients did not receive alvimopan perioperatively, while the subsequent 36 received a single dose of 12 mg preoperatively and then 12 mg every 12 hours for 15 doses or until discharge.

Results: The groups were equal with respect to age, gender, indication, surgeon, and type of diversion. Patients who received alvimopan experienced a shorter length of stay (LOS) versus those in who did not receive alvimopan (10.5 vs. 8.6 days, p = 0.005, 95% CI 0.6-3.3). Readmission for ileus was low in both alvimopan and control groups (0% and 4.4%, respectively). Costs were significantly lower in the alvimopan group than the control groups (2012 USD 32,443 vs. 40,604 p <0.001). This difference stood up to multivariate analysis with a $7,062 difference in hospital stay.

Conclusions: Use of alvimopan in the routine perioperative care of our cystectomy and urinary diversion patients has decreased LOS by 1.9 days. Additionally, institution of routine perioperative alvimopan has reduced costs by $7,062 per admission (20% reduction). This demonstrates a real world application of alvimopan at a moderate volume center.

No MeSH data available.


Related in: MedlinePlus