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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 6/2021

01-06-2021 | Methylnaltrexone | Review Article

Selective Opioid Antagonists Following Bowel Resection for Prevention of Postoperative Ileus: a Systematic Review and Meta-analysis

Authors: Tyler McKechnie, Tharani Anpalagan, Simarpreet Ichhpuniani, Yung Lee, Karim Ramji, Cagla Eskicioglu

Published in: Journal of Gastrointestinal Surgery | Issue 6/2021

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Abstract

Background

Postoperative ileus (POI) remains a common complication following bowel resection. Selective opioid antagonists have been increasingly studied as prophylactic pharmaceutical aids to reduce rates of POI. The aim of this study was to evaluate the impact of selective opioid antagonists on return of bowel function following bowel resection.

Methods

MEDLINE, Embase, and CENTRAL were systematically searched. Articles were included if they compared the incidence of POI and/or length of stay (LOS) in patients receiving and not receiving selective opioid antagonists following elective bowel resection. A pairwise meta-analyses using inverse variance random effects was performed.

Results

From 636 citations, 30 studies with 45,051 patients receiving selective opioid antagonists (51.3% female, mean age: 60.9) and 55,071 patients not receiving selective opioid antagonists (51.2% female, mean age: 61.1) were included. Patients receiving selective opioid antagonists had a significantly lower rate of POI (10.1% vs. 13.8%, RR 0.68, 95%CI 0.63–0.75, p < 0.01). Selective opioid antagonists also significantly reduced LOS (MD − 1.08, 95%CI − 1.47 to − 0.69, p < 0.01), readmission (RR 0.94, 95%CI 0.89–0.99, p = 0.03), and 30-day morbidity (RR 0.85, 95%CI 0.79–0.90, p < 0.01). Improvements in LOS, readmission rate, and morbidity were not significant when analysis was limited to laparoscopic surgery. There was no significant difference in inpatient healthcare costs (SMD − 0.33, 95%CI − 0.71–0.04, p = 0.08).

Conclusions

Rate of POI decreases with the use of selective opioid antagonists in patients undergoing bowel resection. Selective opioid antagonists also improve LOS, rates of readmission, and 30-day morbidity for patients undergoing open bowel resection. Addition of these medications to enhance recovery after surgery protocols should be considered.
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Metadata
Title
Selective Opioid Antagonists Following Bowel Resection for Prevention of Postoperative Ileus: a Systematic Review and Meta-analysis
Authors
Tyler McKechnie
Tharani Anpalagan
Simarpreet Ichhpuniani
Yung Lee
Karim Ramji
Cagla Eskicioglu
Publication date
01-06-2021
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 6/2021
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-021-04973-8

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