McCann Carson P, Brandel Michael G, Wali Arvin R, Steinberg Jeffrey A, Pannell J Scott, Santiago-Dieppa David R, Khalessi Alexander A
Department of Neurosurgery, University of California, San Diego, CA, USA.
J Cerebrovasc Endovasc Neurosurg. 2023 Dec;25(4):380-389. doi: 10.7461/jcen.2023.E2023.05.003. Epub 2023 Jul 20.
Middle meningeal artery embolization (MMAe) has burgeoned as a treatment for chronic subdural hematoma (cSDH). This study evaluates the safety and short-term outcomes of MMAe patients relative to traditional treatment approaches.
In this retrospective large database study, adult patients in the National Inpatient Sample from 2012-2019 with a diagnosis of cSDH were identified. Cost of admission, length of stay (LOS), discharge disposition, and complications were analyzed. Propensity score matching (PSM) was utilized.
A total of 123,350 patients with cSDH were identified: 63,450 without intervention, 59,435 surgery only, 295 MMAe only, and 170 surgery plus MMAe. On PSM analysis, MMAe did not increase the risk of inpatient complications or prolong the length of stay compared to conservative management (p>0.05); MMAe had higher cost ($31,170 vs. $10,768, p<0.001) than conservative management, and a lower rate of nonroutine discharge (53.8% vs. 64.3%, p=0.024). Compared to surgery, MMAe had shorter LOS (5 vs. 7 days, p<0.001), and lower rates of neurological complications (2.7% vs. 7.1%, p=0.029) and nonroutine discharge (53.8% vs. 71.7%, p<0.001). There was no significant difference in cost (p>0.05).
MMAe had similar LOS and decreased odds of adverse discharge with a modest cost increase compared to conservative management. There was no difference in inpatient complications. Compared to surgery, MMAe treatment was associated with decreased LOS and rates of neurological complications and nonroutine discharge. This nationwide analysis supports the safety of MMAe to treat cSDH.
脑膜中动脉栓塞术（MMAe）已迅速发展成为治疗慢性硬膜下血肿（cSDH）的一种方法。本研究评估了MMAe患者相对于传统治疗方法的安全性和短期疗效。
在这项回顾性大型数据库研究中，确定了2012年至2019年美国国家住院样本中诊断为cSDH的成年患者。分析了住院费用、住院时间（LOS）、出院处置情况和并发症。采用倾向得分匹配（PSM）方法。
共确定了123350例cSDH患者：63450例未接受干预，59435例仅接受手术，295例仅接受MMAe，170例接受手术加MMAe。经PSM分析，与保守治疗相比，MMAe不会增加住院并发症风险或延长住院时间（p>0.05）；MMAe的费用高于保守治疗（31170美元对10768美元，p<0.001），非常规出院率较低（53.8%对64.3%，p=0.024）。与手术相比，MMAe的住院时间较短（5天对7天，p<0.001），神经并发症发生率较低（2.7%对7.1%，p=0.029），非常规出院率较低（53.8%对71.7%，p<0.001）。费用方面无显著差异（p>0.05）。
与保守治疗相比，MMAe的住院时间相似，不良出院几率降低，费用略有增加。住院并发症无差异。与手术相比，MMAe治疗可缩短住院时间，降低神经并发症发生率和非常规出院率。这项全国性分析支持了MMAe治疗cSDH的安全性。
