O-031 30-day emergency department utilization for chronic subdural hematomas following surgical evacuation with and without middle meningeal artery embolization

Background Middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDHs) has been found to be associated with fewer treatment failures compared to surgical evacuation. The present study compares 30-day emergency department (ED) utilization for patients with cSDHs with and without adjunctive MMA embolization. Methods All patients who presented with a cSDH to a quaternary center from January 1st, 2018 to December 31, 2020 were retrospectively reviewed. Patients were separated into two cohorts: surgery alone and combined surgery with MMA embolization. The surgery only cohort comprised of patients who presented during the first two years of the cohort. The combined surgery and MMA embolization cohort comprised of all patients with a combined treatment during the entire three-year study period. Patients in the combined cohort comprised of planned combined therapies, as well as patients who failed surgery and required MMA embolization. Primary outcome compared was 30-day ED presentation and readmission. Patients with bilateral treatment were analyzed for admission cSDH size. Results Of the 137 patients who met the study criteria, 28 patients (20%) had combined MMA embolization and surgery. In the 28 combined patients, 15 (54%) were planned MMA embolization and 13 (46%) were due to surgical failure. There was no difference between the two cohorts in mean age, gender, admission Glasgow Coma Score (GCS), discharge GCS, comorbidities, or previous trauma. The mean cSDH size on presentation in the surgery alone cohort (N=123, 20.5mm, sD 6.9) was comparable to the combined group (N=32, 18.7mm, sD 4.5) (p=0.16). A significant higher percentage of patients in the surgery alone (N=32, 29%) cohort presented within 30-days to the ED compared to combined MMA embolization with surgery (N=2, 7%) (p=0.02). There was no significant difference in readmission rates between the surgery alone (N=16, 15%,) and combined cohort (N=1, 4%) (p=0.11). Nine patients (8%) in the surgery alone cohort were readmitted due to significant reaccumulation/residual compared to only one patient (4%) in the combined group (p=0.4). Conclusion Combined MMA embolization and surgical evacuation in cSDH patients appears to be associated with decrease 30-day ED utilization compared to surgery alone. Disclosures J. Catapano: None. C. Nguyen: None. V. Srinivasan: None. C. Rutledge: None. T. Cole: None. J. Baranoski: None. S. Elmasry: None. M. Lawton: None. A. Jadhav: None. A. Ducruet: None. F. Albuquerque: None.