Background Postoperative ileus (POI) is a major cause of
morbidity, increased length of stay (LOS) and hospital cost
after colorectal surgery. Alvimopan is a l-opioid antagonist
used to accelerate upper and lower gastrointestinal
function after bowel resection. We hypothesized that
alvimopan would reduce LOS in patients undergoing colorectal
resection with stoma, a situation that has not been
evaluated.
Methods A retrospective review (2010–2015) identified 58
patients who underwent colorectal resection for benign or
malignant disease with stoma creation and received alvimopan.
They were case-matched to 58 non-alvimopan
patients based on age, BMI, baseline comorbidities, stoma
type created and surgical approach. We compared overall
LOS, incidence ofPOI and other postoperative complications.
Results There were equal numbers of laparoscopic
(N = 18) and open resections (N = 40) in the alvimopan
group and non-alvimopan group. There were also equal
numbers of patients with an ileostomy (N = 37) or
colostomy (N = 21) in each group. Overall, 41 patients
underwent resection for malignant disease in the alvimopan
group compared to 37 in the non-alvimopan group. There
was a significant reduction in median LOS overall
(alvimopan 5 (4–7) versus control 6 (4.75–9.25) days,
P = 0.03). While the 6-day median LOS was similar for
patients undergoing ileostomy creation (P = 0.25), alvimopan
patients had a 3-day decreased median LOS that
approached statistical significance (P = 0.06). The overall
30-day complication rate was higher in the control group
(41.4 vs. 51.7%, P = 0.26), but the readmission rate within
30 days was higher in the alvimopan group (19 vs. 13.8%,
P = 0.45). Neither of these differences reached statistically
significance.
Conclusion The use of alvimopan in patients undergoing
colorectal resection with stoma is associated with a significantly
shorter LOS, but the increased readmission rate
warrants further study. Based on these data, alvimopan
should be evaluated in a controlled setting for patients
undergoing colorectal resection with colostomy creation.