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01-04-2017 | Original Article

Redefining the implications of nasogastric tube placement following radical cystectomy in the alvimopan era

Authors: Vignesh T. Packiam, Vijay A. Agrawal, Joseph J. Pariser, Andrew J. Cohen, Charles U. Nottingham, Shane M. Pearce, Norm D. Smith, Gary D. Steinberg

Published in: World Journal of Urology | Issue 4/2017

Abstract

Purpose

Alvimopan has decreased ileus and need for nasogastric tube (NGT) after radical cystectomy (RC). However, the natural history of ileus versus intestinal obstruction in patients receiving alvimopan is not well defined. We sought to examine the implications of NGT placement before and after the introduction of alvimopan for RC patients.

Methods

Retrospective review identified 278 and 293 consecutive patients who underwent RC before and after instituting alvimopan between June 2009 and May 2014. Baseline characteristics and postoperative outcomes were compared by alvimopan status. Multivariate logistic regression was performed to assess the impact of alvimopan on rates of NGT placement and reoperation for bowel complications.

Results

The cohorts had similar age, stage, approach, and BMI. Patients receiving alvimopan had decreased ileus (16 vs 32 %, p < 0.01) but similar rates of reoperation for bowel complications (2.8 vs 2.7 %). On multivariate analysis, alvimopan was associated with lower risk of NGT placement (OR 0.30, p < 0.01). For patients requiring NGT placement, there was an increased rate of reoperation among patients receiving alvimopan compared with those who did not (28 vs 11 %, p = 0.03). Patients receiving alvimopan who needed NGT had significantly increased median length of stay (22 vs 7 days), need for TPN (66 vs 5.3 %), and readmission for ileus (10.3 vs 2.3 %) compared with those who did not require NGT.

Conclusions

Alvimopan significantly reduced the incidence of ileus and NGT placement following RC. NGT placement was associated with an increased need for reoperation for bowel complications in the setting of alvimopan.

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Title: Redefining the implications of nasogastric tube placement following radical cystectomy in the alvimopan era
Authors: Vignesh T. Packiam
Vijay A. Agrawal
Joseph J. Pariser
Andrew J. Cohen
Charles U. Nottingham
Shane M. Pearce
Norm D. Smith
Gary D. Steinberg
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 4/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1910-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Redefining the implications of nasogastric tube placement following radical cystectomy in the alvimopan era

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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