The Need for Postoperative Chest X-Ray After Placement of Hypoglossal Nerve Stimulator

Objective: Hypoglossal nerve stimulation (HGNS) is a surgical treatment for obstructive sleep apnea (OSA) in patients intolerant to CPAP. Current practice often involves chest x-ray (CXR) in the postanesthesia care unit (PACU), though the incidence of pulmonary complications is low. This study evaluates the necessity of immediate postoperative CXR after HGNS placement.

Methods: We conducted a retrospective chart review of 361 patients who underwent unilateral HGNS placement from 2014 to 2021 at a single institution. Surgeries were performed by two high-volume sleep surgeons. Data collected included demographics, preoperative sleep study results, postoperative CXR findings, and subsequent management. Logistic regression calculated odds ratios (ORs) for the association between abnormal CXR findings and patient characteristics, with mean differences and 95% confidence intervals (CIs) for continuous variables.

Results: Abnormal CXR findings occurred in five patients (1.4%), including two pneumothoraxes (0.6%) and three pulmonary edemas (0.8%). Patients with abnormal CXR findings had increased odds of reporting respiratory symptoms in the PACU compared to those without (OR: 3.8, 95% CI: 1.1-13.2, p < 0.001) and required extended postoperative stays. All patients with pulmonary edema had respiratory symptoms before CXR confirmation. No significant demographic or clinical differences were found between patients with normal and abnormal CXR findings.

Conclusion: This study confirms the low incidence of pulmonary complications following HGNS placement by high-volume surgeons. Immediate CXR may not be necessary in asymptomatic patients. However, routine postoperative imaging in the recovery period is warranted to document hardware placement.

Level Of Evidence: 4: