Implementing a Streamlined Hypoglossal Nerve Stimulator Pathway: Cost, Time to Surgery, and Outcomes

Area of Science:

• Otolaryngology
• Sleep Medicine
• Surgical Innovation

Background:

• Obstructive sleep apnea (OSA) affects millions globally, with hypoglossal nerve stimulator (HGNS) implantation as a key treatment.
• Traditional HGNS implantation involves a multi-stage process, potentially increasing costs and delaying treatment.
• Optimizing the HGNS pathway is crucial for improving patient access and care efficiency.

Purpose of the Study:

• To evaluate the cost-effectiveness, surgical timing, and clinical outcomes of a streamlined HGNS implantation pathway.
• To compare a novel same-day drug-induced sleep endoscopy (DISE) and HGNS implantation pathway against the traditional two-stage approach.

Main Methods:

• Retrospective cohort study of 68 OSA patients undergoing HGNS implantation from 2016-2023.
• Streamlined pathway: In-office laryngoscopy selection, immediate DISE, and HGNS implantation in one encounter.
• Traditional pathway: Separate DISE and subsequent HGNS implantation on a different date.

Main Results:

• The streamlined pathway significantly reduced hospital costs by an average of $9258 (P=.002).
• Time to surgery decreased by a mean of 3.82 months (P=.013) with the streamlined approach.
• Both pathways achieved comparable reductions in apnea-hypopnea index and Epworth Sleepiness Scale scores.

Conclusions:

• A streamlined HGNS pathway can expedite treatment and lower costs for select OSA patients.
• Clinical efficacy is maintained, offering a viable alternative to the traditional two-stage procedure.
• Further research is needed to refine patient selection criteria and assess long-term results.