Presentation Authors: Tzu-Hao Huang*, Matthew Mossanen, Mark Preston, Boston, MA, Benjamin I. Chung, Stanford, CA, William J. Huang, Taipei City, Taiwan, Steven L. Chang, Boston, MA
Introduction: Radical cystectomy (RC) is associated with significant morbidities and one of the most common issues is postoperative ileus. Alvimopan, an opioid antagonist, is approved to accelerate gastrointestinal recovery in bowel surgeries. While prior studies assessing the benefit of alvimopan for RC patients showed benefit but they were limited due to being institutional studies with small sample sizes. In this study, we evaluated the impact of alvimopan on RC with population-based data, which is generalizable to the larger medical community. We hypothesize that alvimopan shortens length of stay (LOS) and reduces hospital cost in patients undergoing RC.
Methods: We identified patients who underwent RC for bladder cancer from 2010 to 2015 in the Premier Healthcare Database, a hospital discharge database capturing approximately 20% of all hospitalizations in the United States. To minimize unmeasured confounders, we compared patients who received alvimopan versus those who did not receive alvimopan only in hospitals with an evidence of administering alvimopan. We utilized the hospital chargemaster data and ICD-9 codes to determine patient and hospital characteristics, the primary outcomes of LOS and hospital cost, and the secondary outcomes of major complications (Clavien grades 3-5) and 90-day readmission for ileus.
Results: A total of 1087 patients met inclusion criteria with 511 (47%) patients receiving alvimopan and 576 (53%) who received no alvimopan. Patient characteristics were well balanced between the two arms of the study. Alvimopan was associated with shorter median LOS (-1.21 days, 95% CI: -1.67 to -0.74, p < 0.001) and cost savings (-$1,817, 95% CI: -$3,544 to -$90, p=0.039), attributed to reduced room and board costs, which outweighed increased pharmacy costs (Figure). There were significantly fewer readmissions for ileus among patients receiving alvimopan (OR 0.61, 95% CI: 0.39 to 0.95, p=0.029). There was no difference between two groups regarding postoperative major complications.
Conclusions: Alvimopan is associated with a shortened LOS, decreased hospital costs, and reduced readmission for ileus among patients undergoing RC. These data suggest that routine use of alvimopan among patients undergoing RC may reduce the burden of bladder cancer on the health care system.