Immediate perioperative safety and resource utilization of stand-alone middle meningeal artery embolization and stand-alone surgical evacuation for chronic subdural hematoma

Objective Randomized trials will ultimately determine whether stand-alone middle meningeal artery embolization (MMAE) is effective in preventing the recurrence of chronic subdural hematoma (cSDH). We therefore characterized in-hospital complications, length of stay, and discharge disposition among adults undergoing stand-alone MMAE for non-traumatic cSDH in the United States. Methods We conducted a retrospective cohort analysis using the National Inpatient Sample (2016–2022) to identify adult patients (≥18 years) with a primary diagnosis of nontraumatic cSDH. Primary outcomes included inpatient complications, non-home discharge (NHD), and extended length of stay (eLOS). 1:5 Propensity score matching (PSM) and multivariable regression were adjusted for baseline differences, including demographics, frailty (mFI-5), illness severity (APR-DRG subclass), and comorbidities. Presenting symptomatology (encephalopathy, gait instability, weakness, headache, etc.) was incorporated into both matching and regression models. Results Of 65,340 patients, 3390 (5.2%) underwent MMAE and 61,950 (94.8%) underwent surgery. After PSM, 1740 MMAE and 6525 surgical patients were analyzed. Following adjustment for demographics, frailty, illness severity, comorbidities, and presenting symptoms, standalone surgery remained significantly associated with increased inpatient morbidity and resource utilization. Compared to MMAE, surgery carried 1.8x the odds of any complication ( P < .0001), 3.1x the odds of non-home discharge ( P < .0001), and 2.2 times the odds of extended length of stay ( P < .0001). There were no significant differences in in-hospital mortality ( P = .991) or cost outlier status ( P = .558). Conclusions In this nationally representative sample (unmatched and matched cohorts), stand-alone MMAE demonstrated a 3–4% inpatient mortality and a 20% overall complication rate.