• Jean Filo, Mira Salih, Omar Alwakaa, Felipe Ramirez-Velandia, Max Shutran, Rafael A Vega, Martina Stippler, Efstathios Papavassiliou, Ron L Alterman, Ajith Thomas, Philipp Taussky, Justin Moore, and Christopher S Ogilvy.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2024 Sep 1; 189: e168e176e168-e176.

BackgroundThis study aims to evaluate the length of stay (LOS) in patients who had adjunct middle meningeal artery embolization (MMAE) for chronic subdural hematoma after conventional surgery and determine the factors influencing the LOS in this population.MethodsA retrospective review of 107 cases with MMAE after conventional surgery between September 2018 and January 2024 was performed. Factors associated with prolonged LOS were identified through univariable and multivariable analyses.ResultsThe median LOS for MMAE after conventional surgery was 9 days (interquartile range = 6-17), with a 3-day interval between procedures (interquartile range = 2-5). Among 107 patients, 58 stayed ≤ 9 days, while 49 stayed longer. Univariable analysis showed the interval between procedures, type of surgery, MMAE sedation, and the number of complications associated with prolonged LOS. Multivariable analysis confirmed longer intervals between procedures (odds ratio [OR] = 1.52; P < 0.01), ≥2 medical complications (OR = 13.34; P = 0.01), and neurological complications (OR = 5.28; P = 0.05) were independent factors for lengthier hospitalizations. There was a trending association between general anesthesia during MMAE and prolonged LOS (P = 0.07). Subgroup analysis revealed diabetes (OR = 5.25; P = 0.01) and ≥2 medical complications (OR = 5.21; P = 0.03) correlated with a LOS over 20 days, the 75th percentile in our cohort.ConclusionsThe interval between procedures and the number of medical and neurological complications were strongly associated with prolonged LOS in patients who had adjunct MMAE after open surgery. Reducing the interval between the procedures and potentially performing both under 1 anesthetic may decrease the burden on patients and shorten their hospitalizations.Copyright © 2024 Elsevier Inc. All rights reserved.

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