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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

Forest plot evaluating the effect of alvimopan on 30-day readmission
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Figure 3: Forest plot evaluating the effect of alvimopan on 30-day readmission

Mentions: Four of 5 studies evaluated the frequency of all-cause hospital readmission within the first 30 days from hospital discharge (Fig. 3) [23,25-27]. There did not appear to be a difference in the frequency of readmission within 30 days of hospital discharge among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45). There was no statistically significant heterogeneity (I2<50%).


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)

Forest plot evaluating the effect of alvimopan on 30-day readmission
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Forest plot evaluating the effect of alvimopan on 30-day readmission
Mentions: Four of 5 studies evaluated the frequency of all-cause hospital readmission within the first 30 days from hospital discharge (Fig. 3) [23,25-27]. There did not appear to be a difference in the frequency of readmission within 30 days of hospital discharge among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45). There was no statistically significant heterogeneity (I2<50%).

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