We would like to thank Dr Kehlet for commenting on our article.
1
He raises important points about the complexity of distinguishing the role of alvimopan
in the setting of enhanced recovery after surgery (ERAS) protocols. Although our use
of a national multi-institutional database such as Vizient provided the advantages
of a large cohort and patient-level data, it did not include details of whether or
not patients were included in ERAS protocols, or information regarding the use of
nonpharmacologic ERAS interventions. We accounted for common pharmacologic components
of ERAS protocols by adjusting for opioid-sparing analgesics, including acetaminophen,
gabapentin, ketamine, and ketorolac. Although not a perfect solution, we believe that
this allowed us to better isolate alvimopan-associated effects and reduce the likelihood
that alvimopan was simply a surrogate marker for inclusion in an ERAS protocol. In
our adjusted analysis, alvimopan was associated with a greater effect ratio in decreasing
duration of stay compared with all other medications.To read this article in full you will need to make a payment
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References
- Alvimopan and outcome after colectomy?.Surgery. 2020; 167: 676-677
- Opioid prescribing after surgery in the United States, Canada, and Sweden.JAMA Netw Open. 2019; 2e1910734
- The opioid component of delayed gastrointestinal recovery after bowel resection.J Gastrointest Surg. 2011; 15: 1259-1268
Article info
Publication history
Published online: November 27, 2019
Accepted:
October 11,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Alvimopan and outcome after colectomy?SurgeryVol. 167Issue 3
- PreviewBased on a large administrative database, Henning et al.1 concluded that alvimopan was associated with decreased length of stay (LOS) after both open and laparoscopic colon resections. However, the conclusion of their study may be seriously questioned because of the methodologic issues hindering exact interpretation. First, there is no detailed information about enhanced recovery (ERAS) pathways and where several initial studies not quoted have similar or lower LOS despite no use of alvimopan. Second, and most surprising, alvimopan is a peripheral opioid antagonist assumed to be effective when opioids are used.
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