Ambulatory Surgical Center a Safe, Efficient Option for Hypoglossal Nerve Stimulator Implantation in OSA Patients

by Linda Kossoff •

What are the complications and efficiencies of hypoglossal nerve stimulator (HGNS) implantation in an ambulatory surgery center (ASC) versus hospital outpatient departments (HOPDs) for obstructive sleep apnea (OSA) treatment?

BOTTOM LINE

Hypoglossal nerve stimulator implantation in an ASC is safe and is more efficient than in an HOPD and may also be more cost-effective.

BACKGROUND: Traditional surgical procedures for OSA patients are mostly performed in a hospital due to these patients’ increased risk of respiratory events and because the surgeries involve airway manipulation. Conversely, HGNS implantation does not involve airway manipulation, yet it is also generally performed in a hospital rather than an ASC.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medicine, New York, N.Y.

SYNOPSIS: Researchers identified patients who received HGNS implantation at a single institution’s HOPD or ACS between May 2015 and January 2021. Of these patients, 122 met the inclusion criteria. There was no significant difference in age, body mass index, smoking status, or Charlson-Deyo Comorbidity Index between the surgical groups. Patient characteristics, surgical times, and complications were summarized as medians with interquartile ranges, and proportions in each surgical setting group were compared. Resulting data revealed that intervals between in-room and case start, case finish and out-of-room, and time in the postoperative area were significantly shorter in the ASC group compared to the HOPD group. Moreover, Medicare reimbursement on a national level was estimated at 18% lower for patients with surgery performed at the ASC. There was an overall low rate of perioperative complications for patients with HGNS implantation for both groups, with no significant difference in complication rates. These findings suggest that HGNS implantation at an ASC in appropriately selected patients is safe and efficient. Limitations included its retrospective design and differences in gender and AHI distribution of patients between groups.

CITATION: Morse E, Han C, Suurna M. Hypoglossal nerve stimulator implantation in an ambulatory surgery center versus hospital. Laryngoscope. 2022;132:706-710.