Letter to the Editor| Volume 167, ISSUE 3, P677, March 2020

Response to: “Alvimopan and outcome after colectomy?”

Published:November 27, 2019DOI:
      We would like to thank Dr Kehlet for commenting on our article.
      • Kehlet H.
      Alvimopan and outcome after colectomy?.
      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kehlet H.
        Alvimopan and outcome after colectomy?.
        Surgery. 2020; 167: 676-677
        • Ladha K.S.
        • Neuman M.D.
        • Broms G.
        • et al.
        Opioid prescribing after surgery in the United States, Canada, and Sweden.
        JAMA Netw Open. 2019; 2e1910734
        • Beard T.L.
        • Leslie J.B.
        • Nemeth J.
        The opioid component of delayed gastrointestinal recovery after bowel resection.
        J Gastrointest Surg. 2011; 15: 1259-1268

      Linked Article

      • Alvimopan and outcome after colectomy?
        SurgeryVol. 167Issue 3
        • Preview
          Based 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.
        • Full-Text
        • PDF