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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

Cost per hospitalization with and without alvimopan (thousands 2012 USD).
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Figure 0002: Cost per hospitalization with and without alvimopan (thousands 2012 USD).

Mentions: Costs were lower in the alvimopan group in the 35 patients with available cost data versus the 47 in the pre–alvimopan cohort. The mean cost was $40,604 in the pre–alvimopan group (2012 USD) compared to the alvimopan group mean of $32,443 (p <0.001) for a savings of $8,161 or 20% reduction of cost. When adjusting for the significantly different preoperative and perioperative variables of epidural, PCA, indication, robotic technique, OR time, EBL, and ICU disposition, the mean costs remained lower in the alvimopan group by $7,062 (p = 0.003) (Figure 2).


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)

Cost per hospitalization with and without alvimopan (thousands 2012 USD).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Cost per hospitalization with and without alvimopan (thousands 2012 USD).
Mentions: Costs were lower in the alvimopan group in the 35 patients with available cost data versus the 47 in the pre–alvimopan cohort. The mean cost was $40,604 in the pre–alvimopan group (2012 USD) compared to the alvimopan group mean of $32,443 (p <0.001) for a savings of $8,161 or 20% reduction of cost. When adjusting for the significantly different preoperative and perioperative variables of epidural, PCA, indication, robotic technique, OR time, EBL, and ICU disposition, the mean costs remained lower in the alvimopan group by $7,062 (p = 0.003) (Figure 2).

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