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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.
Key Words: cystectomy <> alvimopan <> bladder cancer <> urinary diversion <> length-of-stay <> cost-effectiveness
INTRODUCTION
Cystectomy and urinary diversion is a procedure frequently (10-23% incidence) complicated by post-operative ileus [1-7]. Ileus can result in pain limiting mobility, vomiting with increased risk of dehiscence and aspiration, threatened nutritional status, and is associated with a greater risk of additional complications and death. Costs are increased in the setting of ileus because of increased testing and LOS [8]. Recovery of bowel function governs length of stay in many bowel surgeries but also in cystectomy and urinary diversion. Numerous interventions to prevent postoperative ileus and hasten recovery of bowel function have been practiced and studied including early feeding, ambulation [9], avoidance of nasogastric tube [10], omission of mechanical bowel prep...