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Introduction: Time to recovery of GI function is a major determinant of length of stay (LOS) in patients undergoing intestinal resection. Alvimopan, a selective gut µ-receptor antagonist, has been demonstrated to accelerate GI recovery and reduce LOS after open bowel surgery in five multicenter prospective, randomized controlled trials when utilized in the setting of enhanced recovery pathways. Despite the relatively high cost of the drug, large case control studies have estimated reductions in total hospital costs in patients receiving Alvimopan but based upon regional cost data. The purpose of this study was to evaluate clinical and economic outcomes (direct costs) for Alvimopan use in laparoscopic surgery at a single institution.
Methods: The medical records at Huntington Hospital were queried retrospectively between January 2010 and June 2012 for all patients ≥18 years of age who underwent elective, laparoscopic small bowel, colon and/or rectal resections with anastomoses (with/without diverting stomas). Patient who required TPN or end ostomies were excluded. Patients were collected from a cohort of two surgeons who frequently use Alvimopan. Characteristics of patients who received Alvimopan were compared with historical controls of patients who did not receive Alvimopan. Outcome measures including LOS, complications, readmission rates, and direct hospital costs were compared.
Results: In this 27-month period, 94 patients underwent laparoscopic resections. Surgical indications included cancer (n=46, 49%) and diverticulitis (n=31, 33%) with the remaining 17 (18%) consisting of inflammatory bowel disease, colostomy reversal, and rectal prolapse. The mean age of all patients was 62.5±12.6 years, and 54 (57%) were female. The laparoscopic procedures included 31 (33%) right colon resections, 56 (60%) left, sigmoid or low anterior colon resections, 3 (3%) reversal of colostomies, and 4 (4%) small bowel resections. There were no differences between the groups for these parameters. For these cohorts of patients, use of this drug was associated with shorter LOS and reduced total direct hospital costs (net of drug costs, see table 1). There were no differences between the groups in mortality, GI morbidity, superficial or deep surgical site infections, or rates of reoperation or readmission.
Conclusions: Consistent with the tightly controlled RCTs in open bowel resections showing a reduction in post-operative ileus and LOS, broadened use of Alvimopan in laparoscopic surgery was associated with a reduction in LOS and direct hospital costs without increasing complication rates.
Laparoscopic Resections

	Control n=55 (mean)	Alvimopan n=39 (mean)	Difference	p-value
LOS(days,SD)	5±2.2	3.9±1.5	-1.1 days	0.007
Direct Hospital Cost ($,SD)	10091±4038	8558±2038	-$1533	0.032