Cost Savings on Inpatient Hospitalization for Middle Meningeal Artery Embolization in the Setting of Increased Case Volume and Low Complications Rate

Abstract

Middle meningeal artery(MMA) embolization for the treatment of chronic subdural hematomas(cSDH) is becoming increasingly prevalent. It is essential to optimize the safety and cost effectiveness of the post-procedural management. In this study, we examined our cases over time to determine the most appropriate post-procedural destination. This is a retrospective study of patients who underwent MMA embolization for cSDH at our institution. The study cohort was divided into two groups based on the year of embolization. Baseline characteristics, post-procedural complications, and length of stay were compared. Patients with shorter ICU stay were also compared to those with longer stay. Univariate statistical analysis was performed. 92 MMA embolizations for cSDH have been performed at our institution, of which 36(39.1%) were done between 2019 and 2022 and 56(60.9%) after 2023. No patients experienced stroke, cranial nerve palsy, or intraparenchymal hemorrhage after embolization. All but 5 patients were admitted to the intensive care unit(ICU) post-embolization, of which 59(64.1%) were downgraded after one day. Factors associated with a longer ICU stay included pre-operative location(p = 0.002) and need for surgery(p = 0.02). Of those who came from home or non-monitored bed, 82% were downgraded from the ICU in less than 2 days. The average cost of one night in the ICU, IMC, and non-monitored unit was $3,671.75, $2,605.22, and $2,303.81 respectively. MMA embolization for cSDH is a safe procedure with low rate of procedure-related complications. In carefully selected patients, the necessity ICU admission post-operatively should be weighed against better hospital resource utilization.