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Does alvimopan enhance return of bowel function in laparoscopic gastrointestinal surgery? A meta-analysis.

Nguyen DL, Maithel S, Nguyen ET, Bechtold ML - Ann Gastroenterol (2015 Oct-Dec)

Bottom Line: Pooling 4 of 5 studies, there was over a 75% relative risk reduction in POI development when patients were given alvimopan compared to placebo (OR 0.24, 95%CI 0.12-0.51, P=0.02).There did not appear to be a difference in frequency of 30-day readmission rate among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45, P=0.62).However, there did not appear to be a significant reduction in all-cause 30-day readmission rate or length of hospitalization.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of California-Irvine, CA (Douglas L. Nguyen, Shelley Maithel), USA.

ABSTRACT

Background: Postoperative ileus (POI) remains a major impediment in patient recovery and leads to longer lengths of stay at the hospital, readmission rates, and hospital costs. Alvimopan, a mu-opioid receptor antagonist, lowers POI incidence following open gastrointestinal surgery, however, little is known about its role on POI prevention among patients undergoing laparoscopic gastrointestinal surgery.

Methods: A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess prevention of POI and hospital readmission.

Results: Five studies were included in the final analysis. Pooling 4 of 5 studies, there was over a 75% relative risk reduction in POI development when patients were given alvimopan compared to placebo (OR 0.24, 95%CI 0.12-0.51, P=0.02). The number needed to treat with alvimopan to prevent one POI episode was 11 patients. There was a modest reduction in the length of hospitalization between 0.2 and 1.6 days. There did not appear to be a difference in frequency of 30-day readmission rate among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45, P=0.62).

Conclusion: Overall, there was a 75% relative risk reduction in POI development among patients undergoing laparoscopic gastrointestinal surgery. However, there did not appear to be a significant reduction in all-cause 30-day readmission rate or length of hospitalization. Future studies will need to address which subset of patients undergoing laparoscopic gastrointestinal surgery will benefit most from alvimopan.

No MeSH data available.


Related in: MedlinePlus

Algorithm demonstrating the article searchPOI, post-operative ileus
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Figure 1: Algorithm demonstrating the article searchPOI, post-operative ileus

Mentions: The initial literature search identified a total of 38 articles and abstracts (Fig. 1). Of the 38 citations found, we excluded 30 duplicate articles, reviews, or assessments that did not exclusively look at laparoscopic surgical technique outcomes with alvimopan use. Among the 8 remaining articles identified, three studies by Wang et al [8], Absher et al [21], and Delaney et al [22] were excluded because their primary endpoints did not include the incidence of POI or 30-day readmission. A total of five studies [23-27] ultimately met our inclusion criteria and were included in the meta-analysis, which compared the effectiveness of alvimopan versus placebo in reducing POI and readmission rates in patients undergoing laparoscopic gastrointestinal surgery.


Does alvimopan enhance return of bowel function in laparoscopic gastrointestinal surgery? A meta-analysis.

Nguyen DL, Maithel S, Nguyen ET, Bechtold ML - Ann Gastroenterol (2015 Oct-Dec)

Algorithm demonstrating the article searchPOI, post-operative ileus
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585395&req=5

Figure 1: Algorithm demonstrating the article searchPOI, post-operative ileus
Mentions: The initial literature search identified a total of 38 articles and abstracts (Fig. 1). Of the 38 citations found, we excluded 30 duplicate articles, reviews, or assessments that did not exclusively look at laparoscopic surgical technique outcomes with alvimopan use. Among the 8 remaining articles identified, three studies by Wang et al [8], Absher et al [21], and Delaney et al [22] were excluded because their primary endpoints did not include the incidence of POI or 30-day readmission. A total of five studies [23-27] ultimately met our inclusion criteria and were included in the meta-analysis, which compared the effectiveness of alvimopan versus placebo in reducing POI and readmission rates in patients undergoing laparoscopic gastrointestinal surgery.

Bottom Line: Pooling 4 of 5 studies, there was over a 75% relative risk reduction in POI development when patients were given alvimopan compared to placebo (OR 0.24, 95%CI 0.12-0.51, P=0.02).There did not appear to be a difference in frequency of 30-day readmission rate among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45, P=0.62).However, there did not appear to be a significant reduction in all-cause 30-day readmission rate or length of hospitalization.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of California-Irvine, CA (Douglas L. Nguyen, Shelley Maithel), USA.

ABSTRACT

Background: Postoperative ileus (POI) remains a major impediment in patient recovery and leads to longer lengths of stay at the hospital, readmission rates, and hospital costs. Alvimopan, a mu-opioid receptor antagonist, lowers POI incidence following open gastrointestinal surgery, however, little is known about its role on POI prevention among patients undergoing laparoscopic gastrointestinal surgery.

Methods: A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess prevention of POI and hospital readmission.

Results: Five studies were included in the final analysis. Pooling 4 of 5 studies, there was over a 75% relative risk reduction in POI development when patients were given alvimopan compared to placebo (OR 0.24, 95%CI 0.12-0.51, P=0.02). The number needed to treat with alvimopan to prevent one POI episode was 11 patients. There was a modest reduction in the length of hospitalization between 0.2 and 1.6 days. There did not appear to be a difference in frequency of 30-day readmission rate among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45, P=0.62).

Conclusion: Overall, there was a 75% relative risk reduction in POI development among patients undergoing laparoscopic gastrointestinal surgery. However, there did not appear to be a significant reduction in all-cause 30-day readmission rate or length of hospitalization. Future studies will need to address which subset of patients undergoing laparoscopic gastrointestinal surgery will benefit most from alvimopan.

No MeSH data available.


Related in: MedlinePlus