TY  - BOOK
AU  - Bandi, Gaurav
AU  - Ghasemian, Seyem Reza
AU  - Hwang, Jonathan J
AU  - Hwang, Mohan Verghese
AU  - Kowalczyk, Kevin
AU  - Lynch, John
AU  - Marchalik, Daniel
AU  - McGeagh, Kevin
AU  - Nissim, Hanaa G
AU  - Venkatesan, Krishnan
AU  - Vora, Anup
TI  - Multi-institutional outcomes and cost effectiveness of using alvimopan to lower gastrointestinal morbidity after cystectomy and urinary diversion
SN  - 1195-9479
KW  - *Cystectomy
KW  - *Gastrointestinal Tract/pp [Physiopathology]
KW  - *Gastrointestinal Tract/su [Surgery]
KW  - *Piperidines/ec [Economics]
KW  - *Piperidines/pd [Pharmacology]
KW  - *Recovery of Function/de [Drug Effects]
KW  - *Urinary Diversion
KW  - Aged
KW  - Cost-Benefit Analysis
KW  - Female
KW  - Gastrointestinal Agents/ec [Economics]
KW  - Gastrointestinal Agents/pd [Pharmacology]
KW  - Gastrointestinal Tract/de [Drug Effects]
KW  - Humans
KW  - Ileus/ep [Epidemiology]
KW  - Incidence
KW  - Male
KW  - Perioperative Period
KW  - Receptors, Opioid, mu/ai [Antagonists & Inhibitors]
KW  - Receptors, Opioid, mu/de [Drug Effects]
KW  - Recovery of Function/ph [Physiology]
KW  - Retrospective Studies
KW  - Time Factors
KW  - Treatment Outcome
KW  - MedStar Washington Hospital Center
KW  - Urology
KW  - Comparative Study
KW  - Journal Article
KW  - Multicenter Study
N2  - CONCLUSION: In our experience, the use of alvimopan perioperatively significantly accelerates the rate of gastrointestinal recovery and hospital discharge, eliminates the need for nasogastric tube decompression, and reduces the incidence of post-operative ileus in patients following radical cystectomy and urinary diversion; INTRODUCTION: Radical cystectomy is associated with significant morbidity and cost, with rates of gastrointestinal complications as high as 30%. Alvimopan is a mu opioid receptor antagonist that has been shown in randomized-control trials to accelerate gastrointestinal recovery in patients undergoing bowel resection with primary anastamosis. We report our experience with gastrointestinal recovery for patients undergoing cystectomy with urinary diversion treated with alvimopan and cost benefit associated; MATERIALS AND METHODS: Between January 2008 and October 2012, 80 patients underwent radical cystectomy with urinary diversion at two institutions. Forty-two patients in our study did not receive alvimopan preoperatively. Thirty-eight patients received perioperative alvimopan and were without postoperative nasogastric decompression. Return of bowel function, initiation of diet, and gastrointestinal complications and estimated cost of hospitalization were evaluated; RESULTS: Times to first flatus (3.1 days versus 4.7 days, p < 0.01, 95% CI 0.96-2.24) and bowel movement (3.9 days versus 4.9 days, p < 0.01, 95% CI 0.45-1.55) were significantly shorter in those patients who received alvimopan. Additionally, the initiation of clear liquid diet (4.1 days versus 5.5 days, p < 0.01, 95% CI 0.70-2.10), regular diet (5.2 days versus 6.3 days, p < 0.01, 95% CI 0.39-1.81) and hospital discharge (6.1 days versus 7.7 days, p = 0.04, 95% CI 0.01-3.21) were accelerated in the alvimopan cohort. There were no incidences of prolonged ileus in patients who received perioperative alvimopan (0% versus 26.2%, p < 0.01). With an approximate average cost of alvimopan administration
ER  -