Factors Associated with Short Hospital Stay After Combined Middle Meningeal Artery Embolization and Surgical Evacuation for Chronic Subdural Hematoma

BACKGROUND: Middle meningeal artery embolization (MMAE) plus surgical evacuation is increasingly used for chronic subdural hematoma (cSDH), but predictors of length of stay (LOS) and outcomes associated with early discharge remain unclear. METHODS: We performed a multicenter MESH Registry study (2019-2024) of patients undergoing MMAE and surgical evacuation for symptomatic cSDH. Short-stay discharge was defined as LOS ≤4 days. Predictors were identified using multivariable logistic regression. The 90-day composite adverse event was defined as cSDH recurrence requiring intervention, reintervention (repeat MMAE or surgical evacuation), or 30-day all-cause readmission. Safety was assessed using adjusted logistic regression, generalized estimating equations (GEE), inverse probability of treatment weighting (IPTW), and multiple imputation by chained equations (MICE). RESULTS: Among 647 patients (mean age 72.6 years; 74.0% male), 156 (24.1%) had short-stay discharge. Median LOS was 8 days (IQR 5-15). Older age (aOR 0.76 per 10 years; 95% CI 0.62-0.93; P = 0.008), higher baseline modified Rankin Scale score (aOR 0.79 per point; 95% CI 0.67-0.94; P = 0.007), and greater midline shift (aOR 0.90 per mm; 95% CI 0.85-0.96; P = 0.001) were independently associated with lower odds of short-stay discharge. C‑statistic was 0.683. The 90-day composite event rate was 17.1% in short-stay versus 23.7% in long-stay patients. Short-stay discharge was not significantly associated with the composite outcome on adjusted analysis (aOR 0.56; 95% CI 0.30-1.07; P = 0.08), GEE (aOR 0.61; 95% CI 0.33-1.12; P = 0.11), or MICE (aOR 0.74; 95% CI 0.44-1.25; P = 0.26). IPTW showed a discordant association (OR 0.47; 95% CI 0.24-0.92; P = 0.03). CONCLUSIONS: Older age, worse baseline function, and midline shift were associated with longer hospitalization. Short-stay discharge was not associated with a statistically significant increase in adverse-event rates; however, the study was not powered to establish non-inferiority or safety equivalence, and clinically meaningful differences cannot be excluded.

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Journal
Clinical Neuroradiology
Published
2026-08-20
DOI
https://doi.org/10.1007/s00062-026-01713-w
Primary Topic
Neurosurgical Procedures and Complications
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article
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article

Factors Associated with Short Hospital Stay After Combined Middle Meningeal Artery Embolization and Surgical Evacuation for Chronic Subdural Hematoma

Giancarlo Salsano, A Spiotta, Jefferson O. Abaricia, Bruno Del Sette et al.
Clinical Neuroradiology
Neurosurgical Procedures and Complications
article

Factors Associated with Short Hospital Stay After Combined Middle Meningeal Artery Embolization and Surgical Evacuation for Chronic Subdural Hematoma

Giancarlo Salsano, A Spiotta, Jefferson O. Abaricia, Bruno Del Sette, Anil Gopinathan, Santiago Ortega‐Gutiérrez, Hamza Adel Salim, Pietro Panni, Atakan Orscelik, Rabih G. Tawk, Muhammed Amir Essibayi, Dhairya A. Lakhani, Bluyé DeMessie, Fabio Settecase, J Cooper, Davide Saraceno, J Jones, Gaultier Marnat, Caterina Michelozzi, Vladimir Kalousek, Rahim Abo Kasem, Spiros Blackburn, Erez Nossek, Ahmed Aljuboori, R Regenhardt, Sri Hari Sundararajan, Domagoj Gajski, Omar Alwakaa, Hussein H. Nasser, Vitor Mendes Pereira, Peter Sporns, Yan-Lin Li, Thien Huynh, Kunal Vakharia, Mohamad Ezzeldin, Joseph Carnevale, Tufail Patankar, Pietro Mario Santini, Diego Alejandro Ortega, Pascal J. Mosimann, Zachary Abecassis, Pedram D. Maleknia, Samantha Schimmel, Andrew Falzon, Dominik F. Vollherbst, Georgios Sioutas, Mario Zanaty, Jared Knopman, Visish M. Srinivasan, Tang Si Zhao, Jan-Karl Burkhardt, Matthew Alexander, Ali Alaraj, Fawaz Al-Mufti, Abdulrhman Alsalama, Alireza Karandish, Adam A. Dmytriw, Giuseppe Lanzino, Michael R. Levitt, Christopher S. Ogilvy, Leonardo Cruz-Criollo, Khushal Gupta, Anthony Terraciano, Eytan Raz, Nimer Adeeb, Luca Scarcia, Pascal Jabbour, MESH Collaborators, Marco Colasurdo, Markus A. Möhlenbruch, Basel Musmar, Clemens M. Schirmer, David J. Altschul
article en

Abstract

BACKGROUND: Middle meningeal artery embolization (MMAE) plus surgical evacuation is increasingly used for chronic subdural hematoma (cSDH), but predictors of length of stay (LOS) and outcomes associated with early discharge remain unclear. METHODS: We performed a multicenter MESH Registry study (2019-2024) of patients undergoing MMAE and surgical evacuation for symptomatic cSDH. Short-stay discharge was defined as LOS ≤4 days. Predictors were identified using multivariable logistic regression. The 90-day composite adverse event was defined as cSDH recurrence requiring intervention, reintervention (repeat MMAE or surgical evacuation), or 30-day all-cause readmission. Safety was assessed using adjusted logistic regression, generalized estimating equations (GEE), inverse probability of treatment weighting (IPTW), and multiple imputation by chained equations (MICE). RESULTS: Among 647 patients (mean age 72.6 years; 74.0% male), 156 (24.1%) had short-stay discharge. Median LOS was 8 days (IQR 5-15). Older age (aOR 0.76 per 10 years; 95% CI 0.62-0.93; P = 0.008), higher baseline modified Rankin Scale score (aOR 0.79 per point; 95% CI 0.67-0.94; P = 0.007), and greater midline shift (aOR 0.90 per mm; 95% CI 0.85-0.96; P = 0.001) were independently associated with lower odds of short-stay discharge. C‑statistic was 0.683. The 90-day composite event rate was 17.1% in short-stay versus 23.7% in long-stay patients. Short-stay discharge was not significantly associated with the composite outcome on adjusted analysis (aOR 0.56; 95% CI 0.30-1.07; P = 0.08), GEE (aOR 0.61; 95% CI 0.33-1.12; P = 0.11), or MICE (aOR 0.74; 95% CI 0.44-1.25; P = 0.26). IPTW showed a discordant association (OR 0.47; 95% CI 0.24-0.92; P = 0.03). CONCLUSIONS: Older age, worse baseline function, and midline shift were associated with longer hospitalization. Short-stay discharge was not associated with a statistically significant increase in adverse-event rates; however, the study was not powered to establish non-inferiority or safety equivalence, and clinically meaningful differences cannot be excluded.

Clinical Neuroradiology
West Virginia University (US), Barking, Havering And Redbridge University Hospitals NHS Trust (GB), St. Michael's Hospital (CA), Albert Einstein College of Medicine (US), Lehigh Valley Hospital-Pocono (US), Beth Israel Deaconess Medical Center (US), Westchester Medical Center (US), Mayo Clinic (US), The University of Texas MD Anderson Cancer Center (US), Thomas Jefferson University (US), Université de Bordeaux (FR), Medical University of South Carolina (US), Oregon Health & Science University (US), National University of Singapore (SG), University of Washington (US), Cornell University (US), Heidelberg University (DE), University of South Florida (US), Louisiana State University in Shreveport (US), Toronto Western Hospital (CA), Sutter Medical Center (US), Hospital of the University of Pennsylvania (US), Jacksonville College (US), California Pacific Medical Center (US), Nuffield Orthopaedic Centre (GB), University Hospital Heidelberg (DE), University Hospital of Basel (CH), San Raffaele University of Rome (IT), Centre Hospitalier Universitaire Henri-Mondor (FR), University of Alabama at Birmingham (US), University of Illinois Chicago (US), University of Oxford (GB), University of Chicago (US), NYU Langone Health (US), Blanchette Rockefeller Neurosciences Institute (US), Lehigh Valley Health Network (US), Presbyterian Hospital (US), Bordeaux Population Health (FR), St George's Hospital (GB), Sisters of Charity Hospital (HR), Mayo Clinic in Arizona (US), University of Iowa Health Care (US), Lone Star College Kingwood (US), Stadtspital Waid (CH), Ospedale Policlinico San Martino (IT), Mayo Clinic in Florida (US), National University Health System (SG), Geisinger Wyoming Valley Medical Center (US), Neurological Surgery (US), Seattle University (US), The University of Texas Health Science Center at Houston (US)
Stryker, Penumbra, Sirtex Medical
Good health and well-being
Openalex Percentile: Top 10%
Neurosurgical Procedures and Complications
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