Gajjar Avi A, Johnson Drew, Sankar Baradwaj Simha, Dwivedi Dev, Ramachandran Nathan, McNulty Alana, Greene Hayden E, Rosoklija Gavril, Paul Alexandra R
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Interv Neuroradiol. 2025 Sep 8:15910199251375542. doi: 10.1177/15910199251375542.
ObjectiveRandomized 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.MethodsWe 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.ResultsOf 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 ( < .0001), 3.1x the odds of non-home discharge ( < .0001), and 2.2 times the odds of extended length of stay ( < .0001). There were no significant differences in in-hospital mortality ( = .991) or cost outlier status ( = .558).ConclusionsIn this nationally representative sample (unmatched and matched cohorts), stand-alone MMAE demonstrated a 3-4% inpatient mortality and a 20% overall complication rate.
目的
随机试验最终将确定单独的脑膜中动脉栓塞术（MMAE）在预防慢性硬膜下血肿（cSDH）复发方面是否有效。因此，我们对美国因非创伤性cSDH接受单独MMAE治疗的成年人的住院并发症、住院时间和出院处置情况进行了描述。
方法
我们使用国家住院样本（2016 - 2022年）进行了一项回顾性队列分析，以确定原发性诊断为非创伤性cSDH的成年患者（≥18岁）。主要结局包括住院并发症、非家庭出院（NHD）和延长住院时间（eLOS）。采用1:5倾向评分匹配（PSM）和多变量回归对基线差异进行调整，包括人口统计学、虚弱程度（mFI - 5）、疾病严重程度（APR - DRG亚类）和合并症。将出现的症状（脑病、步态不稳、虚弱、头痛等）纳入匹配和回归模型。
结果
在65340例患者中，3390例（5.2%）接受了MMAE，61950例（94.8%）接受了手术。PSM后，对1740例接受MMAE的患者和6525例手术患者进行了分析。在对人口统计学、虚弱程度、疾病严重程度、合并症和出现的症状进行调整后，单独手术仍与住院发病率和资源利用增加显著相关。与MMAE相比，手术发生任何并发症的几率高1.8倍（<0.0001），非家庭出院的几率高3.1倍（<0.0001），延长住院时间的几率高2.2倍（<0.0001）。住院死亡率（=0.991）或费用异常状态（=0.558）无显著差异。
结论
在这个具有全国代表性的样本（未匹配和匹配队列）中，单独的MMAE显示住院死亡率为3 - 4%，总体并发症发生率为20%。
