#1363

Perioperative Naloxegol use in prevention of post-operative ileus in open radical cystectomy

J. Bruinsma¹, P. Viswambaram¹, B. Stewart¹, R. Goodwin¹

¹Sir Charles Gairdner Hospital, Urology, Perth, Australia

Introduction:

Peripherally acting μ-opioid receptor antagonists have been shown to enhance gastrointestinal recovery following major abdominopelvic surgery. Among these, Alvimopan is well-studied and has demonstrated reductions in postoperative ileus, length of hospital stay (LOS), and associated healthcare costs, particularly in procedures such as radical cystoprostatectomy. Naloxegol is considerably more cost-effective than Alvimopan, but its efficacy in this surgical context remains less well established.

Material and methods:

A retrospective cohort study was conducted at a tertiary centre, comparing 23 patients who underwent open radical cystectomy and received perioperative Naloxegol with 9 control patients between 2022 and 2024. Time to return of bowel function, incidence of postoperative ileus, length of hospital stay (LOS) and complication rate.

Results:

Of the 32 patients included, 23 received Naloxegol perioperatively and 9 did not. There was no statistically significant difference in baseline characteristics between groups, including age (71.2 vs 69.9 years, p = 0.88), BMI (28.4 vs 27.8, p = 0.74), or smoking status (p = 0.64). Return of bowel function was similar across both groups, with no significant differences observed in time to flatus (3.0 vs 2.3 days, p = 0.13), time to recommencement of solids (5.7 vs 5.2 days, p = 0.68), or time to first bowel motion (4.8 vs 4.0 days, p = 0.10). However, patients who received Naloxegol had a significantly longer length of stay compared to those who did not (14.5 vs 9.7 days, p = 0.02). There was no difference in complication rate (73% vs 56%, p=0.25).