Alvimopan is a Food and Drug Administration–approved treatment to accelerate gastrointestinal recovery after abdominal surgery; however, benefits may vary across different procedures and contexts of care.
Hence, Mohsen Alhashemi and colleagues from the Department of Surgery, McGill University, Montreal, QC, Canada conducted the study to summarize the evidence regarding the effect of alvimopan on postoperative outcomes after abdominal surgery.
Randomized controlled trials and nonrandomized studies comparing alvimopan versus control were searched out of which nine randomized controlled trials and 35 nonrandomized studies were identified. Risk of bias was assessed using Cochrane's risk of bias tool 2.0 (for randomized controlled trials) and Risk of Bias in Nonrandomized Studies-of Intervention tool (for nonrandomized studies). Results were appraised descriptively as heterogeneity in reporting and risk of bias hindered meta-analysis. Quality of evidence across different surgical procedures and contexts of care (ie, open versus minimally invasive surgery, traditional care versus enhanced recovery pathway) was evaluated using Grading of Recommendations Assessment, Development, and Evaluation.
The following findings were noted-
- Evidence of low to moderate certainty supports that alvimopan reduces length of stay and improves gastrointestinal recovery after open bowel resection and open radical cystectomy.
- Limited evidence supports alvimopan for surgeries not listed in Food and Drug Administration labels (ie, total abdominal hysterectomy and retroperitoneal lymph node dissection).
- Similar effects were observed in traditional and enhanced recovery pathway settings, but enhanced recovery pathway elements varied across studies.
- There is very low certainty of evidence supporting alvimopan for patients undergoing minimally invasive surgery.
Therefore, it was concluded that "alvimopan improves outcomes after open bowel resection and open radical cystectomy. Benefits for patients undergoing minimally invasive surgery and treated in contemporary enhanced recovery pathway settings remain uncertain."
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