Charge Comparison of Standalone Middle Meningeal Artery Embolization to Non-surgical Medical Management for Chronic Subdural Hematoma - A Propensity Score Matched Analysis.

Background

Recent randomized clinical trials have shown middle meningeal artery embolization (MMAE) reduces the need for subsequent burr hole drainage of chronic subdural hematoma (cSDH), both as an adjunct to initial drainage or as a standalone procedure. We compared the 6-month total hospital charges for standalone MMAE (sMMAE) versus nonsurgical medical management in patients with cSDH.

Methods

We retrospectively reviewed patients who presented with unilateral, >1cm in size, cSDH initially managed without drainage from January 1, 2020, through July 30, 2024. Seventy-two patients were identified: 46 managed conservatively and 26 with sMMAE. Propensity score matching (PSM) was performed based on patient age, cSDH size, and length of index hospitalization. The primary endpoint was the mean difference in total hospital charges at 6 months.

Results

After PSM, 23 patients who underwent sMMAE alone were compared to 23 patients receiving nonsurgical medical management. Groups were not significantly different regarding age, Charlson comorbidity index, cSDH size, midline shift size, antiplatelet/anticoagulation, symptoms, and length of index hospitalization, though standardized mean differences remained elevated. Medically treated patients had higher mean total number of hospital days (8.0 vs. 3.0, p=0.03). sMMAE patients had higher mean total 6-month hospital charges ($125K ±34Kvs. $101K ±94K, p=0.02), primarily driven by the procedure itself. Five medically managed patients required rescue drainage, compared with none in the sMMAE group (p=0.05).

Conclusion

Initial treatment of cSDH with sMMAE had higher average 6-month hospital charges compared to medically managed controls. Patients treated with sMMAE had shorter hospital stays and did not require rescue drainage within 6 months.