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Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis
  1. Joshua S Catapano1,
  2. Stefan W Koester2,
  3. Visish M Srinivasan1,
  4. Kavelin Rumalla1,
  5. Jacob F Baranoski1,
  6. Caleb Rutledge1,
  7. Tyler S Cole1,
  8. Ethan A Winkler1,
  9. Michael T Lawton1,
  10. Ashutosh P Jadhav1,
  11. Andrew F Ducruet1,
  12. Felipe C Albuquerque1
  1. 1 Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
  2. 2 School of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  1. Correspondence to Dr Felipe C Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; Felipe.Albuquerque{at}


Background Middle meningeal artery (MMA) embolization results in fewer treatment failures than surgical evacuation for chronic subdural hematomas (cSDHs). We compared the total 1-year hospital cost for MMA embolization versus surgical evacuation for patients with cSDH.

Methods Data for patients who presented with cSDHs from January 1, 2018, through May 31, 2020, were retrospectively reviewed. Patients were grouped by initial treatment (surgery vs MMA embolization), and total hospital cost was obtained. A propensity-adjusted analysis was performed. The primary outcome was difference in mean hospital cost between treatments.

Results Of 170 patients, 48 (28%) underwent embolization and 122 (72%) underwent surgery. cSDHs were larger in the surgical (20.5 (6.7) mm) than in the embolization group (16.9 (4.6) mm; P<0.001); and index hospital length of stay was longer in the surgical group (9.8 (7.0) days) than in the embolization group (5.7 (2.4) days; P<0.001). More patients required additional hematoma treatment in the surgical cohort (16%) than in the embolization cohort (4%; P=0.03), and more required readmission in the surgical cohort (28%) than in the embolization cohort (13%; P=0.04). After propensity adjustment, MMA embolization was associated with a lower total hospital cost compared to surgery (mean difference −$32 776; 95% CI −$52 766 to −$12 787; P<0.001). A propensity-adjusted linear regression analysis found that unexpected additional treatment was the only significant contributor to total hospital cost (mean difference $96 357; 95% CI $73 886 to $118 827; P<0.001).

Conclusions MMA embolization is associated with decreased total hospital cost compared with surgery for cSDHs. This lower cost is directly related to the decreased need for additional treatment interventions.

  • subdural
  • embolic
  • meninges
  • artery

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  • Contributors All authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and drafted the work or revised it critically for important intellectual content; and provided final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JSC - writing, data collection, statistics; SWK - statistics; VMS - edits; KR - statistics; JFB - data collection; CR - data collection; TSC - edits; EAW - edits; MTL - edits; APJ - edits; AFD - edits; FCA - edits, final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AFD is a consultant for Medtronic plc (Dublin, Ireland); Penumbra, Inc. (Alameda, California, USA); Stryker Corp. (Kalamazoo, Michigan, USA); CERENOVUS (Miami, Florida, USA); and KOSWIRE, Inc. (Flowery Branch, Georgia, USA). AFD and FCA serve on the editorial board of the Journal of NeuroInterventional Surgery.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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