How does blood sugar level affect wound infection rates and device revision and removal rates after hypoglossal nerve stimulation in obstructive sleep apnea patients? A large database study

This study aims to evaluate the impact of perioperative hyperglycemia on wound infection, device revision, reimplantation and removal rates after hypoglossal nerve stimulation, utilizing a large-scale and federated, real-world database. A retrospective cohort study was conducted using the TriNetX Network on September 26th, 2025. Patients with OSA who underwent HGNS implantation were classified into the hyperglycemic cohort if their laboratory glucose values exceeded the predefined thresholds (126 mg/dL and 154 mg/dL) during the six months before or after implantation. Otherwise, they were in non-glycemic cohort. Postoperative wound infection and device reoperation rates were assessed at one-year and three-year follow-up. Outcomes were analyzed using incidence rates, odds ratios (ORs), and Log-Rank tests, with propensity score matching (PSM) employed to control for confounding variables. Patients with serum glucose levels ≥ 126 mg/dL and ≥ 154 mg/dL exhibited significantly higher incidence rates of surgery-related wound infections compared to their respective counterparts (one-year OR: 1.56 and 1.82; three-year OR: 1.55 and 1.74; all p ≤ 0.01). These findings remained statistically significant after PSM (one-year OR: 1.51 and 2.08; three-year OR: 1.40 and 1.63; all p < 0.05). However, there were no significant differences, except 3 year OR after PSM, in device revision, replacement or removal rates at both one-year and three-year follow-ups (p > 0.05). Hyperglycemia is associated with significantly increased risk of wound infection, including long term infection following HGNS implantation, while device reoperation rates remain unaffected. These findings underscore the importance of stringent perioperative glycemic control to mitigate postoperative infection risk in HGNS recipients.