Postoperative length of stay comparison associated with a switch from alvimopan to naloxegol in patients undergoing major small and large bowel procedures.

PURPOSE: This retrospective analysis compares postoperative length of stay in patients undergoing colorectal surgery who received naloxegol or alvimopan as part of an Enhanced Recovery After Surgery (ERAS) protocol.

METHODS

This is a systemwide retrospective cohort. The community health system switched from alvimopan to naloxegol as the peripherally acting mu-opioid receptor antagonist (PAMORA) agent used in the colorectal ERAS protocol in December 2024. Adult patients who underwent colorectal surgery and received one PAMORA dose for surgical discharge dates between May 2024 and August 2025 were included.

RESULTS

There was no difference in median length of stay (alvimopan 3.2 days [2.2-6.2] versus naloxegol 3.3 days [2.2-5.9], p = 0.881). Median bowel function return was achieved sooner in patients receiving alvimopan (1.4 days [1.1-2.1] versus 1.7 [1.2-2.4], p = 0.015), however all-cause 30-day readmission rates were higher in the alvimopan group (15.2% versus 8.2%, p = 0.021). Patients in the alvimopan group were more likely to receive a dose prior to the procedure than naloxegol (89.1% versus 76.4%, p < 0.001). A subgroup analysis of those patients revealed there was no difference in median length of stay, median bowel function return, or incidence of postoperative ileus, with higher readmission rates in the alvimopan group (p = 0.005). The average PAMORA cost per admission who received alvimopan was approximately 16 times more expensive than naloxegol.

CONCLUSION

Switching from alvimopan to naloxegol in colorectal ERAS protocols is a potential cost-saving initiative for formulary management that was associated with similar observed length of stay and postoperative ileus rates.