(1327) Healthcare Utilization Following Hypoglossal Nerve Stimulation Implantation: A 10-Year, 651-Patient Analysis

Introduction: Unlike traditional OSA surgeries, hypoglossal nerve stimulation (HGNS) requires longitudinal management including activation, titration, and monitoring. Understanding the healthcare utilization (HCU) burden associated with this longitudinal care is essential for optimizing resource allocation and care delivery models.

Methods: A single-institution, retrospective review of adults following HGNS implantation between 2014-2024 (n=651) was conducted. All postoperative sleep surgery related encounters were manually coded. HCU was analyzed longitudinally and stratified by surgery year, pre- vs. post-COVID-19 period, insurance, age, medical comorbidities, Apnea-Hypopnea index (AHI), and Epworth Sleepiness Scale (ESS).

Results: The cohort (age 62.2±17.7 years, 65.9% male) generated 4,469 postoperative visits, averaging 6.7 visits/patient. Telemedicine increased 4-fold post-pandemic (2.8% to 11.5% of visits; p< 0.001), with nearly half of patients after 2020 completing at least one telemedicine encounter. A graded inverse association was observed between age and telemedicine visit proportion ( < 40 years:13.5% to ≥70 years: 6.4%). Medicare beneficiaries completed significantly more visits than privately insured patients (7.73±4.02 vs. 6.55±3.60 visits; p< 0.01). Postoperative AHI was associated with significantly increased HCU (p < 0.01, 2019-2023), but preoperative AHI, ESS, age, and total comorbidity did not reach significance. An APP was hired to address visit burden, with immediate offload of attending visits (2014-2023= APP < 6% visits; 2024= APP > 9.9% visits; p< 0.01).

Conclusions: Each HGNS procedure generates nearly 7 postoperative visits. Medicare insurance and higher post-operative AHI scores are associated with greater HCU, highlighting the need for risk-stratified follow-up protocols. Post-pandemic telemedicine growth and increased APP utilization suggest opportunities for increased efficiency. As HGNS adoption expands, understanding and addressing care burdens will be critical for optimizing resource allocation and delivering equitable care.