Application of Alvimopan as a Component of Enhanced Recovery After Surgery (ERAS) Protocol for Patients Undergoing Radical Cystectomy and Diversion (C&D)

Authors

Thomas Hardacker, MD, MBA, Thomas Jefferson UniversityFollow
May Jean Counsilman, MD, Thomas Jefferson UniversityFollow
Benjamin H. Rudnick, MD, Thomas Jefferson UniversityFollow
Edouard J. Trabulsi, MD, Thomas Jefferson UniversityFollow
James R. Mark, MD, Thomas Jefferson UniversityFollow
Leonard G. Gomella, MD, Thomas Jefferson UniversityFollow
Mark J. Mann, MD, Thomas Jefferson UniversityFollow
Costas D. Lallas, MD, Thomas Jefferson UniversityFollow
Scott G. Hubosky, MD, Thomas Jefferson UniversityFollow

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Description

Introduction

• Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS)
• C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1)
• Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge
• Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS
• Alvimopan is a μ-opioid receptor antagonist commonly included in ERAS, and limits deleterious effects of narcotics on the GI system
• The goal of this analysis was to determine the effect of Alvimopan on post-operative LOS and 30 day readmission in patients undergoing C&D

Publication Date

6-6-2019

City

Philadelphia

Keywords

quality improvement, Alvimopan, enhanced recovery after surgery, radical cystectomy and diversion

Disciplines

Medicine and Health Sciences | Surgery | Urology

Comments

Presented at the 2019 House Staff Quality Improvement and Patient Safety Conference

Recommended Citation

Hardacker, MD, MBA, Thomas; Counsilman, MD, May Jean; Rudnick, MD, Benjamin H.; Trabulsi, MD, Edouard J.; Mark, MD, James R.; Gomella, MD, Leonard G.; Mann, MD, Mark J.; Lallas, MD, Costas D.; and Hubosky, MD, Scott G., "Application of Alvimopan as a Component of Enhanced Recovery After Surgery (ERAS) Protocol for Patients Undergoing Radical Cystectomy and Diversion (C&D)" (2019). House Staff Quality Improvement and Patient Safety Conference (2016-2019). Poster 132.
https://jdc.jefferson.edu/patientsafetyposters/132