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

Nicholas R Lenze; Jayden Garcia; Punithavathy Vijayakumar; Sonja G Schütz; Michael J Brenner; Jeffrey J Stanley; Paul T Hoff

doi:10.1002/oto2.70007

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

OTO Open. 2024 Oct 2;8(4):e70007. doi: 10.1002/oto2.70007. eCollection 2024 Oct-Dec.

Authors

Nicholas R Lenze¹, Jayden Garcia¹, Punithavathy Vijayakumar², Sonja G Schütz², Michael J Brenner¹, Jeffrey J Stanley¹, Paul T Hoff¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School Ann Arbor Michigan USA.
² Department of Neurology, Sleep Disorders Center University of Michigan Medical School Ann Arbor Michigan USA.

Abstract

Objective: To evaluate the costs, time to surgery, and clinical outcomes associated with implementing a streamlined hypoglossal nerve stimulator (HGNS) implantation pathway.

Study design: Retrospective cohort study.

Setting: Single tertiary care center in the United States from 2016 to 2023.

Methods: Patients with a lack of complete concentric collapse of the velum during volitional snore on in-office laryngoscopy qualified for the streamlined HGNS pathway. This pathway consisted of confirmatory drug-induced sleep endoscopy (DISE) followed immediately by HGNS implantation during the same surgical encounter. Outcomes were compared to patients in the traditional pathway (standalone DISE followed by HGNS implantation on a later date).

Results: A total of 68 patients (13 streamlined, 55 traditional) with obstructive sleep apnea who underwent HGNS implantation were included. Patients were predominately male (70.6%) and White (95.6%) and had a mean (SD) age of 63.5 (10.0) years. The streamlined pathway was associated with a significant reduction in both hospital costs (mean difference $9258, 95% confidence interval [CI]: 3690-14,825; P = .002) and time to surgery (mean decrease of 3.82 months, 95% CI: 0.83-6.80 months; P = .013) compared to the traditional pathway. Patients in both groups had reduction in apnea-hypopnea index and Epworth Sleepiness Scale score, with no significant differences in comparisons between groups.

Conclusion: In select patients, the streamlined HGNS pathway may expedite time to surgery and reduce hospital costs with comparable clinical outcomes to a traditional 2-stage pathway. Further research is warranted to validate patient selection and better understand longitudinal outcomes.

Keywords: cost‐benefit analysis; electric stimulation therapy; hospital costs; hypoglossal nerve; obstructive sleep apnea; patient‐reported outcome measures; time‐to‐treatment.