Neurosurgery 93:1082–1089, 2023
Surgical evacuation is the standard treatment for chronic subdural hematomas (CSDHs) but is associated with a high risk of recurrence and readmission. Middle meningeal artery embolization (MMAE) is a novel treatment approach which could be performed upfront or in adjunction to surgical evacuation. MMAE studies are limited by small sample sizes. This study aimed to describe and compare outcomes of MMAE in adjunction to surgery with those of surgery alone on a national level.
METHODS: The national Vizient Clinical Database was queried by use of a speciﬁc validated set of International Classiﬁcation of Diseases, Tenth Revision codes (October 2018-June 2022). Patients with the diagnosis of nontraumatic CSDH who received MMAE and surgical drainage in the same hospitalization were identiﬁed, and their outcomes were compared with isolated surgical drainage.
RESULTS: A total of 606 subjects from 156 institutes and 6340 subjects from 369 institutes were included in the MMAE plus surgery (M&S) and surgery groups, respectively. Average length of stay was signiﬁcantly longer in the M&S group (9.87 vs 7.53 days; P < .01). There was no signiﬁcant difference in the in-hospital mortality rate (2.8% vs 2.9%), but the complication rate was signiﬁcantly higher in the M&S group (8.7% vs 5.5%; P < .01). Complications that were signiﬁcantly more common in the M&S group included aspiration pneumonia, postoperative sepsis, and anesthesia-related. Mean direct costs were signiﬁcantly higher in the M&S group (28 834 vs 16 292 US dollars; P < .01). The 30-day readmission rate was signiﬁcantly lower in the M&S group compared with the surgery group (4.2% vs 8.0%; P < .01).
CONCLUSION: This analysis of large-scale national data indicates that MMAE performed in adjunction to surgery for treatment of CSDH is associated with higher direct costs, higher complication rates, and longer length of stay but lower readmission rates compared with surgical evacuation alone.