A Retrospective Study of Patients Undergoing Radical Cystectomy and Receiving Peri-Operative Naloxegol or Alvimopan: Comparison of Length of Stay
Journal of Surgery
Volume 6, Issue 5, October 2018, Pages: 129-134
Received: Aug. 27, 2018;
Accepted: Sep. 10, 2018;
Published: Oct. 12, 2018
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Taylor Goodstein, Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
Bryn Launer, Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
Sharon White, Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
Madison Lyon, Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
Nicholas George, Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
Kailynn DeRonde, Connecticut Children's Medical Center, Hartford, USA; School of Pharmacy, University of Connecticut, Storrs, USA
Michelle Burke, Department of Pharmacy, University of Colorado Hospital, Aurora, USA
Colin O’Donnell, Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
Clark Lyda, Department of Pharmacy, University of Colorado Hospital, Aurora, USA
Tyree H. Kiser, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, USA
Shandra Wilson, Division of Urology, Department of Surgery, University of Colorado Hospital, Aurora, USA
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Alvimopan is a µ-opioid receptor antagonist used in the post-operative period to decrease rates of post-operative ileus (POI) following radical cystectomy (RC) and thereby shorten length of stay (LOS). Naloxegol is a much less expensive drug of the same class that has yet to be studied for prevention of POI in the peri-operative period. The purpose of the current study is to evaluate the differences in LOS and development of POI in patients post-RC who take alvimopan versus those who take naloxegol, with the hope that drug efficacy can be evaluated against the significant difference in cost burden between the two drugs. The study population included all adult patients between 18–89 years of age with bladder cancer undergoing radical cystectomy with urostomy at University of Colorado Hospital. Those patients who received usual post-operative care as well as either alvimopan or naloxegol between September 2011 and December 2017 were selected for analysis. Patients who did not take either medication or were switched from one drug to the other were excluded from the study. A zero-truncated binomial regression analysis was used to analyze differences in length of stay in patients who received alvimopan versus those who received naloxegol. Additionally, the incidence of post-operative ileus was compared between treatment groups. 130 patients who underwent RC and received either alvimopan or naloxegol were included in the study: 75 (58%) received alvimopan and 55 (42%) received naloxegol. Baseline characteristics were similar between treatment groups. There was no significant difference in the length of stay between patients who received alvimopan and patients who received naloxegol after adjusting for age, sex, BMI, length of surgical time, or stage of disease (p = 0.41). There was no significant between the two drugs for development of POI (p = 0.85). Development of POI was significantly associated with a longer LOS (p = 0.007). The analysis showed that naloxegol was comparable to alvimopan when it came to length of hospital stay following RC. Therefore, naloxegol may be offered as a less expensive, effective alternative to alvimopan.
Alvimopan, Naloxegol, Post-operative Ileus, Length of Stay, µ-opioid Receptor Antagonist, Radical Cystectomy
To cite this article
Tyree H. Kiser,
A Retrospective Study of Patients Undergoing Radical Cystectomy and Receiving Peri-Operative Naloxegol or Alvimopan: Comparison of Length of Stay, Journal of Surgery.
Vol. 6, No. 5,
2018, pp. 129-134.
Copyright © 2018 Authors retain the copyright of this article.
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