Medication use evaluation of alvimopan in a teaching hospital

Introduction: Post-Operative ileus (POI) is one of the most expected complications of major abdominal surgery. It is the most common cause of delayed hospital discharge. POI results from inflammatory reaction and effects of opioids analgesics. Alvimopan is an opioid antagonist, designed to mitigate the effects of opioids on the GI tract without interfering with ability to control pain. Methods: The objective of this study is to examine the quality of evidence associated with use of alvimopan at NYU Langone Hospital – Long Island and associated costs. This is a retrospective chart review study, included patients who received alvimopan during June 2020 – July 2021. Efficacy and toxicity of alvimopan were evaluated. Results: We included 385 patients in our study. Median age is 63 y/o, females make up 64% of patients. Most common surgeries include laparoscopic colon resections; open total abdominal hysterectomies; open total abdominal hysterectomies and salpingoophorectomy. Fentanyl is most commonly used surgical anesthesia (95%); followed by hydromorphone (31%), and morphine (3%). Two hundred and seventeen (217) of 385 patients (56.4%) were given alvimopan according FDA labeling. Alvimopan was administered after surgery in 100 patients (26%). 205 (53%) alvimopan use was in procedures where high-quality evidence was found with alvimopan use: open colorectal surgery and cystectomy; 141 (37%) use was in procedures where mixed-quality evidence was found with alvimopan use: total abdominal hysterectomy, laparoscopic colorectal surgery; and 39 (10%) alvimopan use was in procedures where low-quality evidence found with alvimopan use: any other surgical procedure and/or unapproved dosing. About $90,000 of the cost is attributable to low-quality evidence dosing strategy. In regards to efficacy, POI occurred in 65 (17%) of patients, 6 (2%) of patients were re-admitted; length of stay (LOS) was 3 days. Median days to solid food is 2 days; median days to first bowel movement is 0 days. In regards to safety, elevated troponin was seen in one patient. Conclusions: Overall, there was a high degree of alvimopan use based on low-quality evidence. There were no safety concerns associated with the use of alvimopan. Furthermore, about $90,000 of the cost is attributable to low-quality evidence dosing strategy.