Postoperative ileus: Impact of pharmacological treatment, laparoscopic surgery and enhanced recovery pathways

Table 1 Overview of RCT trials 2004-2008 of alvimopan

Author	Number of patients	Primary end point	GI2 improvement (h)	GI3 improvement (h)	Hazard ratio	DCO improvement (h)
Wolff et al[57]	510	GI3	20.01	15.01	1.281	13.01
			28.02	22.02	1.542	20.02
Viscusi et al[56]	666	GI3	16.41	7.51	1.201	14.21
			13.72	9.92	1.242	15.22
Delaney et al[55]	451	GI3	15.21	14.11	1.451	14.01
			10.52	7.52	1.282	7.22
Ludwig et al[53]	654	GI2	20.02	16.02	1.502	17.02
Buchler et al[58]	911	GI3	14.31	8.51	1.181	8.11
			10.72	4.82	1.372	5.92

¹6 mg alvimopan;

²12 mg alvimopan. Hazard ratio: The ratio of two hazard rates. Hazard rate is defined as the probability to failure given survival to date. DCO: Discharge order; GI²: The time to recovery of GI function, a composite end points that represent full upper and lower recovery. i.e. time that the patient first tolerated solid food and time that the patient first passed a bowel movement; GI³: The time to recovery of GI function, a composite end points that represents full upper and lower recovery. i.e. time that the patient first tolerates solid food, or time that the patient first passes flatus or a bowel movement.

Table 2 Effect of interventions to improve gastrointestinal recovery and reduce LOS

Trials	Type of study	Intervention	Improvement passage flatus	Improvement first bowel movement	Decrease in LOS
Noble et al[52]	Meta analysis	Chewing gum	14 h	23 h	1.1 d
Delaney et al[54]	Pooled analysis	Alvimopan	12 h1 (6 mg)	15 h2 (6 mg)	18.4 h3
			15 h1 (12 mg)	18 h2 (12 mg)
Delaney et al[28]	Observational multicenter study	Laparoscopic surgery	NA	0.7 d2	1.7 d3
Walter et al[69]	Meta analysis	ERP	NA	NA	3.64 d

¹Defined as GI³;

²Defined as GI²;

³Discharge order written. Standard elective open colorectal resection is usually associated with LOS of 8-12 d. Pharmacological treatment, laparoscopic surgery and ERP have substantially decreased LOS after surgery. LOS: Length of stay; ERP: Enhanced recovery pathways; NA: Not available.