Factors Associated with Short Hospital Stay After Combined Middle Meningeal Artery Embolization and Surgical Evacuation for Chronic Subdural Hematoma
Year: 2026
Type: article
Study design: Observational Study
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.
Source: Clinical Neuroradiology
Authors: Anthony Terraciano, Bluyé DeMessie, Muhammed Amir Essibayi, Abdulrhman Alsalama, Khushal Gupta, Hamza Adel Salim, Alireza Karandish, Nimer Adeeb, Dhairya A. Lakhani, Yan-Lin Li, Diego Alejandro Ortega, Joseph Carnevale, Atakan Orscelik, Zachary Abecassis, Georgios Sioutas, Giancarlo Salsano, Rahim Abo Kasem, Andrew Falzon, Jefferson O. Abaricia, Pedram D. Maleknia, Leonardo Cruz-Criollo, Samantha Schimmel, Basel Musmar, Matthew Alexander, Ahmed Aljuboori, Dominik F. Vollherbst, Domagoj Gajski, Jared Cooper, Omar Alwakaa, Mohamad Ezzeldin, Christopher S. Ogilvy, Fawaz Al-Mufti, Vladimir Kalousek, Markus A. Möhlenbruch, Luca Scarcia, Tang Si Zhao, Peter B. Sporns, Anil Gopinathan, Robert W. Regenhardt, Spiros L. Blackburn, Clemens M. Schirmer, Thien Huynh, Rabih G. Tawk, Fabio Settecase, Pascal Jabbour, Kunal Vakharia, Mario Zanaty, Santiago Ortega-Gutierrez, Jesse G. Jones, Marco Colasurdo, Hussein H. Nasser, Sri Hari Sundararajan, Pascal J. Mosimann, Erez Nossek, Eytan Raz, Alejandro M. Spiotta, Bruno Del Sette, Ali Alaraj, Caterina Michelozzi, Davide Saraceno, Pietro Panni, Visish M. Srinivasan, Jan-Karl Burkhardt, Gaultier Marnat, Pietro Mario Santini, Michael R. Levitt, Giuseppe Lanzino, Jared Knopman, Vitor Mendes Pereira, Tufail Patankar, Adam A. Dmytriw, David J. Altschul, MESH Collaborators
Institutions: Albert Einstein College of Medicine, University of Illinois Chicago, The University of Texas MD Anderson Cancer Center, Louisiana State University, Louisiana State University in Shreveport, West Virginia University, University of Oxford, St. Michael's Hospital, University of Toronto, NewYork–Presbyterian Hospital, Weill Cornell Medicine, Mayo Clinic, University of Washington, Hospital of the University of Pennsylvania, University of Pennsylvania, Ospedale Policlinico San Martino, Medical University of South Carolina, St George's Hospital, St George's, University of London, Oregon Health & Science University, University of Alabama at Birmingham, University of Iowa, University of Iowa Hospitals and Clinics, University of Iowa Health Care, University of South Florida, Thomas Jefferson University, Sutter Medical Center, University Hospital Heidelberg, University of Applied Health Sciences, Sisters of Charity Hospital, Westchester Medical Center, New York Medical College, Beth Israel Deaconess Medical Center, Harvard University, HCA Healthcare, Centre Hospitalier Universitaire Henri-Mondor, Hôpitaux Universitaires Henri-Mondor, National University of Singapore, National University Hospital, National University Health System, University Hospital of Basel, Stadtspital Zürich, The University of Texas Health Science Center at Houston, Mayo Clinic in Florida, Sutter Health, California Pacific Medical Center, Lehigh Valley Health Network, Lehigh Valley Hospital, Toronto Western Hospital, NYU Langone Health, New York University, IRCCS Ospedale San Raffaele, Université de Bordeaux, Barking, Havering And Redbridge University Hospitals NHS Trust, Queen's Hospital
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,190
Funders: Stryker, Penumbra, Sirtex Medical
OpenAlex ID: W7203833487