0674 Real-World Post-Discharge Outcomes in Patients with Obesity Hypoventilation Syndrome Treated with CPAP or BPAP

Abstract Introduction Patients with obesity hypoventilation syndrome (OHS) experience high healthcare utilization and are frequently discharged from the hospital on positive airway pressure (PAP) or noninvasive ventilation (NIV). Although guidelines recommend NIV at discharge after hypercapnic respiratory failure, real-world post-hospital practices and outcomes for patients started on different PAP modalities remain poorly characterized. Methods We conducted a retrospective cohort study of adults (≥18 years) admitted to a tertiary hospital within a large integrated health system in Los Angeles from January to December 2024 who were newly discharged with PAP therapy, identified through durable medical equipment data. Patients were included as suspected OHS based on BMI criteria or serum bicarbonate >30 mEq/L. Those discharged to hospice or who died during the index hospitalization were excluded. Demographic characteristics, comorbidities, and post-discharge outcomes were obtained from the electronic medical record. Results Thirty-seven patients with suspected OHS met inclusion criteria: 14 discharged with continuous positive airway pressure (CPAP) and 23 with bilevel positive airway pressure (BPAP). CPAP group (n=14): Mean BMI 66 kg/m2, bicarbonate 31 mEq/L, age 69 years; 64% female; mean Charlson Comorbidity Index (CCI) 6.5. Thirty-day readmission occurred in 35%, and 64% completed outpatient follow-up within an average of 13 days. BPAP group (n=23): Mean BMI 43 kg/m2, bicarbonate 33 mEq/L, age 66 years; 35% female; mean CCI 5. Thirty-day readmission occurred in 30%, and 65% completed follow-up within an average of 14 days. There was no statistically significant difference in 30-day readmission rates between CPAP and BPAP groups (p>0.05). Independent of modality, patients who completed outpatient follow-up within four weeks had significantly lower readmission risk. Conclusion In this single-center cohort, suspected OHS patients discharged on CPAP had similar early readmission and follow-up outcomes compared with those discharged on BPAP. These findings suggest CPAP may be a reasonable discharge option in selected OHS patients when timely outpatient follow-up is ensured. Ongoing work will expand the cohort and assess longer-term outcomes to inform optimal care transition strategies for this high-risk population. Support (if any)