A Statewide, Community-Based Assessment of Alvimopan's Effect on Surgical Outcomes

Harbaugh, Calista M.; Al-Holou, Shaza N.; Bander, Thomas S.; Drews, Joseph D.; Shah, Muazzum M.; Terjimanian, Michael N.; Cai, Sanjun; Campbell, Darrell A.; Englesbe, Michael J.

doi:10.1097/sla.0b013e31826c37f1

Cited by 29 publications

(9 citation statements)

References 10 publications

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“…In total, 54 publications were included with a total number of 18 983 patients. Seventeen studies were RCTs , four were case–control studies , nine were prospective studies and 24 were retrospective studies . The methodological quality of the included studies is shown in Tables and .…”

Section: Resultsmentioning

confidence: 99%

Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta‐analysis

et al. 2016

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Section: Resultsmentioning

confidence: 99%

Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta‐analysis

et al. 2016

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“…First, our dataset lacked colectomy-specific complications that may better explain extended LOS such as prolonged postoperative ileus, though the expected ileus rate for the cohort is far less than the amount of unexplained extended LOS. 23 Second, while our risk-adjustment models accounted for patient illness, procedure type and acuity, we lacked data on factors such as patient rurality, access to transportation, discharge planning and care coordination which undoubtedly influence LOS as well. Third, we analyzed a common gastrointestinal procedure and our results may not apply to different procedures.…”

Section: Discussionmentioning

confidence: 99%

Extended Length of Stay After Surgery

2014

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Importance With recent health policy focus on shifting risk to providers, hospital leaders are increasing efforts to reduce excessive resource use, such as patients with extended length of stay (LOS) after surgery. However, it is unclear the degree to which extended LOS represents complications, patient illness, or inefficient practice style. Objective We sought to examine the influence of complications on hospital extended LOS rate variation after colorectal resections. Design Retrospective cohort study. Setting Hospitals participating in the 2009 American College of Surgeons National Surgical Quality Improvement Project (199 hospitals) Participants Adults undergoing inpatient colorectal resections (N=22,664 patients) Exposures Inpatient complications recorded in the ACS-NSQIP dataset. Inpatient complications were identified by their postoperative date of occurrence’s relationship to the patient’s surgical discharge date. Main outcome measures Risk-adjusted hospital extended LOS rates, defined as the proportion of patients with hospital stay greater than 75th percentile for the entire cohort. Results Forty-three percent of patients with extended LOS did not have a documented inpatient complication. While there was wide variation in both risk-adjusted extended LOS (15%–35%) and risk-adjusted inpatient complication (12%–29%) rates, there was only weak correlation (Spearman’s rho 0.56) between the two. Only half (52%) of the variation in hospital extended LOS rates was attributable to hospital inpatient complication rates. Conclusions and Relevance Much of the variation in hospital risk-adjusted extended LOS rates is not attributable to patient illness or complications and therefore most likely represents differences in practice style. Efforts to reduce excess resource utilization should focus on the efficiency of care, such as increased adoption of enhanced recovery pathways.

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“…(11–13) While these studies consistently showed that alvimopan is associated with either faster return of bowel function or shorter LOS, the magnitude of effect varied between studies. While this variation is expected given differences between RCTs and non-randomized effectiveness evaluations, (21, 22) it complicates the determination of the effectiveness of the drug.…”

Section: Discussionmentioning

confidence: 99%

“…Concerns over the effectiveness of alvimopan persist as several well-done observational studies have reported LOS savings greater than one day. (11–13) Additionally, some believe that the cost of the drug is excessive and unwarranted even though it is estimated to be approximately $67.50 per pill or $937.50 for a full course of seven days of treatment (14) and few patients actually receive the full course. Both of these factors may prevent adoption of alvimopan in routine clinical care.…”

Section: Introductionmentioning

confidence: 99%

Alvimopan Use, Outcomes, and Costs: A Report from the Surgical Care and Outcomes Assessment Program Comparative Effectiveness Research Translation Network Collaborative

Ehlers

Simianu

Bastawrous

et al. 2016

Journal of the American College of Surgeons

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Background Randomized trials show that alvimopan hastens return of bowel function and reduces length of stay by one day among patients undergoing colorectal surgery. However, its effectiveness in routine clinical practice and impact on hospital costs remains uncertain. Study Design We performed a retrospective cohort study of patients undergoing elective colorectal surgery in Washington State (2009–2013) using data from a clinical registry (Surgical Care and Outcomes Assessment Program) linked to a statewide hospital discharge database (Comprehensive Hospital Abstract Reporting System). We used generalized estimating equations to evaluate the relationship between alvimopan and outcomes while adjusting for patient, operative, and management characteristics. Hospital charges were converted to costs using hospital-specific charge-to-cost ratios, and were adjusted for inflation to 2013 dollars. Results Among 14,781 patients undergoing elective colorectal surgery at 51 hospitals, 1,615 (11%) received alvimopan. Patients who received alvimopan had a LOS that was 1.8 days shorter (p<0.01) and costs that were $2,017 lower (p<0.01) compared to those who did not receive alvimopan. After adjustment, LOS was 0.9 days shorter (p<0.01), and hospital costs were $636 lower (p=0.02) among those receiving alvimopan compared to those who did not. Conclusions When used in routine clinical practice, alvimopan was associated with a shorter LOS and limited but significant hospital cost savings. Both efficacy and effectiveness data support the use of alvimopan in routine clinical practice, and its use could be measured as a marker of higher quality care.

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A Statewide, Community-Based Assessment of Alvimopan's Effect on Surgical Outcomes

Cited by 29 publications

References 10 publications

Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta‐analysis

Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta‐analysis

Extended Length of Stay After Surgery

Alvimopan Use, Outcomes, and Costs: A Report from the Surgical Care and Outcomes Assessment Program Comparative Effectiveness Research Translation Network Collaborative

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