Clinical neurology and neurosurgery · 2026
Adjunctive middle meningeal artery embolization is associated with lower 30-day readmission and mortality in chronic subdural hematoma: A propensity-matched national analysis.
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Al Saiegh Fadi, Kotzur Travis, Tao Emma, Webb Matthew, Mascitelli Justin, Seifi Ali
Аннотация
OBJECTIVE: To evaluate whether adjunctive middle meningeal artery (MMA) embolization is associated with lower 30-day readmission and mortality in patients undergoing surgical evacuation for chronic subdural hematoma (cSDH).
METHODS: The National Readmissions Database (NRD), 2020 through 2022, was used to identify adults undergoing surgical evacuation for cSDH with or without MMA embolization during the index admission. Primary outcomes were 30-day readmission and in-hospital mortality. Propensity score matching was performed, and outcomes were analyzed using modified Poisson regression with Bonferroni correction for the two primary outcomes. Analyses incorporated NRD survey weights with Taylor series linearization. E-values were calculated to assess sensitivity to unmeasured confounding.
RESULTS: Of 4918 patients (2218 with MMA embolization, 2700 with surgery alone), 2028 were retained after matching. On post-match regression analysis, MMA embolization was associated with lower 30-day readmission (8.8% vs 11%; RR 0.82, 95% CI 0.68-0.97; p = 0.024) and in-hospital mortality (2.4% vs 4.5%; RR 0.52, 95% CI 0.32-0.85; p < 0.001), both significant after Bonferroni correction. Readmission for recurrent SDH was also lower (RR 0.37, 95% CI 0.19-0.72; p = 0.004); hospital charges were higher, with no difference in length of stay. The E-value for the mortality association was 3.26 (1.63 for the upper 95% CI limit) suggesting that the mortality benefit is unlikely to be explained by unmeasured confounding alone.
CONCLUSIONS: Adjunctive MMA embolization was independently associated with lower 30-day readmission and in-hospital mortality. These real-world data suggest that MMA embolization may be associated with improved short-term outcomes, supporting further prospective evaluation.
METHODS: The National Readmissions Database (NRD), 2020 through 2022, was used to identify adults undergoing surgical evacuation for cSDH with or without MMA embolization during the index admission. Primary outcomes were 30-day readmission and in-hospital mortality. Propensity score matching was performed, and outcomes were analyzed using modified Poisson regression with Bonferroni correction for the two primary outcomes. Analyses incorporated NRD survey weights with Taylor series linearization. E-values were calculated to assess sensitivity to unmeasured confounding.
RESULTS: Of 4918 patients (2218 with MMA embolization, 2700 with surgery alone), 2028 were retained after matching. On post-match regression analysis, MMA embolization was associated with lower 30-day readmission (8.8% vs 11%; RR 0.82, 95% CI 0.68-0.97; p = 0.024) and in-hospital mortality (2.4% vs 4.5%; RR 0.52, 95% CI 0.32-0.85; p < 0.001), both significant after Bonferroni correction. Readmission for recurrent SDH was also lower (RR 0.37, 95% CI 0.19-0.72; p = 0.004); hospital charges were higher, with no difference in length of stay. The E-value for the mortality association was 3.26 (1.63 for the upper 95% CI limit) suggesting that the mortality benefit is unlikely to be explained by unmeasured confounding alone.
CONCLUSIONS: Adjunctive MMA embolization was independently associated with lower 30-day readmission and in-hospital mortality. These real-world data suggest that MMA embolization may be associated with improved short-term outcomes, supporting further prospective evaluation.