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Emergency Department Visits for Chronic Subdural Hematomas within 30 Days after Surgical Evacuation with and without
J S Catapano1, L Scherschinski1, K Rumalla1
1From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Insights
Adding middle meningeal artery embolization to surgery for chronic subdural hematomas reduces 30-day emergency department visits. This combined approach shows promise in improving patient outcomes and reducing healthcare utilization.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Chronic subdural hematoma (CSH) management often involves surgical evacuation.
- Recurrence and complications can lead to significant healthcare resource utilization.
Purpose of the Study:
- To compare the rate of 30-day emergency department (ED) visits for patients with CSH treated with surgery alone versus surgery plus middle meningeal artery embolization (MMAE).
Main Methods:
- Retrospective review of 137 CSH patients treated between 2018-2020.
- Treatment groups: surgery only vs. surgery + MMAE.
- Primary outcome: 30-day ED presentation and readmission rates.
Main Results:
- A significantly lower percentage of patients undergoing surgery + MMAE presented to the ED within 30 days (7%) compared to surgery alone (29%; P = .02).
- No significant difference in readmission rates was observed between the groups (4% vs. 15%; P = .11).
- CSH size was comparable between groups at presentation.
Conclusions:
- Adjunctive MMAE to surgical evacuation for CSH is associated with a reduction in 30-day ED visits.
- This combined treatment strategy may decrease treatment failures and improve patient management post-surgery.
Background And Purpose:
Middle meningeal artery embolization after surgical evacuation of a chronic subdural hematomas is associated with fewer treatment failures than surgical evacuation. We compared emergency department visits within 30 days for patients with chronic subdural hematomas with and without adjunctive middle meningeal artery embolization.
Materials And Methods:
All cases of chronic subdural hematoma treated from January 1, 2018, through December 31, 2020, were retrospectively reviewed. Treatment was classified as surgery only or surgery combined with middle meningeal artery embolization. The primary outcome was 30-day emergency department presentation and readmission.
Results:
Of 137 patients who met the study criteria, 28 (20%) underwent surgery combined with middle meningeal artery embolization. Of these 28 patients, 15 (54%) underwent planned middle meningeal artery embolization and 13 (46%) underwent embolization after surgical failure. The mean chronic subdural hematoma size at presentation in the group with surgery only (n = 109, 20.5 [SD, 6.9] mm) was comparable with that in the combined group (n = 28, 18.7 [SD, 4.5] mm; P = .16). A significantly higher percentage of the surgery-only group presented to the emergency department within 30 days compared with the combined group (32 of 109 [29%] versus 2 of 28 [7%] patients; P = .02). No significant difference was found with respect to readmission (16 [15%] versus 1 [4%] patient; P = .11). Nine patients (8%) in the surgery-only group were readmitted for significant reaccumulation or residual subdural hematoma compared with only 1 patient (4%) in the combined group (P = .40).
Conclusions:
Surgical evacuation combined with middle meningeal artery embolization in patients with chronic subdural hematoma is associated with fewer 30-day emergency department visits compared with surgery alone.
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