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Background Endovascular embolization is frequently performed in patients with head and neck cancer for hemorrhage control and tumor-related vascular management. However, predictors of post-procedural discharge disposition remain poorly defined, limiting risk stratification and care planning. This study investigates the association between prior healthcare utilization and home discharge following embolization in this population.Methods We performed a retrospective cohort study using Epic Cosmos, a nationwide, multicenter electronic medical record database. Patients with a prior diagnosis of head and neck cancer were selected and then further filtered for treatment with carotid embolization. Patients were stratified by prior healthcare utilization status. The primary outcome was home discharge, mortality was assessed as a secondary outcome. Stratified analyses were conducted across age groups, radiation status, and prior antiplatelet, anticoagulant, and surgical history. Aggregate odds ratios were then calculated within each strata.Results Among 3,836 patients undergoing embolization, home discharge occurred in 83.9% without prior utilization compared with 77.3% with prior utilization(p<0.001). Prior utilization was associated with significantly lower odds of home discharge(OR 0.66,95%CI 0.53-0.82;RR 0.92, 95%CI 0.89-0.96; Fisher exact p<0.001). This association was consistent across age (18-64 years:OR 0.64,95%CI 0.48-0.84,p<0.01; ≥65 years: OR 0.67,95%CI 0.50-0.89,p<0.01) and radiation exposure (no radiation: OR 0.69,95%CI 0.53-0.90,p<0.01; radiation: OR 0.66, 95%CI 0.45-0.97,p=0.035). Significant associations were observed in patients without prior anticoagulant use (OR 0.63,p<0.001) and without prior head and neck surgery (OR 0.64,p<0.001). Mantel-Haenszel pooled analysis confirmed persistent effects after stratification by age (pooled OR 0.65,95%CI 0.53-0.80) and radiation status (pooled OR 0.68,95%CI 0.55-0.85), with no evidence of effect heterogeneity across strata. Ninety-day mortality was consistent across utilization types of varying clinical severity, ranging from 19.0% to 22.0%.Conclusions Prior healthcare utilization is independently associated with a lower likelihood of home discharge following embolization in patients with head and neck cancer. Consistent mortality across utilization types suggests that prior healthcare utilization may be more relevant for predicting discharge disposition than short-term survival. These findings suggest that prior utilization may serve as a marker of patient complexity and could inform risk stratification, discharge planning, and peri-procedural resource allocation in this high-risk population.Disclosures A. Goyal: None. B. Sankar: None. A. Paul: 2; C; Microvention, Penumbra.Abstract E-362 Table 190 Day mortality by utilization typeEncounter TypeTelephoneOffice VisitOrders OnlyHospital Outpatient VisitSurgeryEmergency to InpatientMedication RefillEmergencyTotal across all utilization types.Death after Embolization within 1-90 days (%)20.16%19.80%20.10%19.81%19.97%22.02%19.12%20.43%20.28%Abstract E-362 Figure 1