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Background Middle meningeal artery embolization (MMAE) is emerging as a promising adjunctive treatment in patients with chronic subdural hematomas (cSDH). This study presents real world multicenter data comparing outcomes in cSDH patients undergoing surgical treatment alone or combined with MMAE.Methods This multi-institutional, multinational, retrospective, propensity-matched study utilized the TriNetX platform to compare outcomes in patients undergoing surgical evacuation and MMAE versus surgery alone for cSDH. The outcomes included inpatient readmission, need for repeat surgery, and mortality at 6 months following treatment.Results Among 253 108 patients with cSDH, 14 568 underwent surgical evacuation and 711 underwent surgical evacuation with MMAE. Patients who underwent surgical evacuation alone had higher odds of unplanned readmission, need for repeat surgery, and mortality at 6 months, both before and after propensity score matched analysis.Conclusion Patients undergoing MMAE with surgical evacuation for cSDH had reduced mortality along with reduced rates of readmission and reoperation, suggesting MMAE as a valuable adjunct in managing cSDH.