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Background Prolonged hospitalization after combined middle meningeal artery embolization (MMAE) and surgical evacuation for chronic subdural hematoma (cSDH) contributes to delirium, functional decline, and excess healthcare utilization in a predominantly elderly population — yet evidence-based discharge criteria after combined treatment remain undefined. We sought to identify admission-time predictors of short hospital stay and evaluate whether early discharge is associated with 90-day adverse events.Methods Retrospective multicenter cohort study using the MESH Registry across 24 international institutions (2016-2024). Patients undergoing combined MMAE and surgical evacuation for symptomatic cSDH were included; exclusions were age <18, missing LOS data, in-hospital mortality, hospice discharge, and same-day discharge. Short-stay discharge was defined as LOS ≤4 days (lower quartile). Ten prespecified admission-time predictors were evaluated in a multivariable logistic regression model with bootstrap internal validation. Safety was assessed via covariate-adjusted logistic regression, generalized estimating equations (GEE), inverse probability of treatment weighting (IPTW), and multiple imputation (MICE) with delta-adjustment sensitivity analyses.Results Among 647 patients (mean age 72.6 years; 74.0% male) across 22 centers, 156 (24.1%) achieved short-stay discharge. Median LOS was 8 days (IQR 5-15). Increasing age (aOR 0.76 per 10 years; 95% CI 0.62-0.93; P=0.008), higher baseline mRS (aOR 0.79 per point; 95% CI 0.67-0.94; P=0.007), and greater midline shift (aOR 0.90 per mm; 95% CI 0.85-0.96; P=0.001) independently predicted longer stay. C-statistic was 0.683. The 90-day composite adverse event rate was 17.1% vs. 23.7% in short- versus long-stay patients (RD −6.7%; 95% CI −14.4% to 1.0%). Short-stay discharge was not associated with the composite endpoint on adjusted analysis (aOR 0.56; 95% CI 0.30-1.07; P=0.08), GEE (aOR 0.61; 95% CI 0.33-1.12; P=0.11), or MICE (aOR 0.74; 95% CI 0.44-1.25; P=0.26). IPTW yielded a discordant significant result (OR 0.47; P=0.03), likely reflecting residual confounding from surgical technique.Conclusions Younger age, better baseline functional status, and lesser midline shift identify patients most likely to achieve short-stay discharge after combined MMAE and surgical evacuation. Early discharge was not associated with increased adverse events across primary and sensitivity analyses, supporting feasibility of accelerated discharge pathways in selected patients. Prospective studies incorporating surgical technique are needed to establish formal criteria.Disclosures A. Terraciano: None. A. Karandish: None. H. Salim: None. M. Collaborators: None.