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Introduction Chronic and subacute subdural hematomas (SDH) are associated with significant morbidity and mortality, and high recurrence rates. While conventional surgical drainage (CSD) is a commonly used intervention to reduce symptoms of SDH, middle meningeal artery embolization (MMAe) is an emerging adjunctive treatment to CSD reducing risk of recurrence. This study investigated differences in outcomes among patients with traumatic SDH treated with CSD+MMAe versus those treated with CSD alone.Methods Using the Premier Healthcare Database (PHD), adult patients (≥18 years) with a primary diagnosis of traumatic chronic or subacute SDH who underwent either CSD with adjunctive MMAe or CSD alone during the same inpatient hospital admission were identified between January 2021 and November 2024. Study outcomes included in-hospital mortality, procedural-related complications, and combined 1-year hospital readmissions & ER visits. The inverse probability of treatment weighting (IPTW) method was employed to balance covariates (including patient demographics, clinical characteristics and hospital characteristics). Generalized estimating equation (GEE) models were performed to compare study outcomes between the two cohorts.Results After applying study inclusion and exclusion criteria, 18,374 patients were included in final study sample (with 1,543 patients in the adjunct MMAe with CSD group and 16,831 patients in the CSD stand-alone group). The two cohorts were well balanced on study covariates after weighting. Patients with traumatic SDH treated with CSD+MMAe had 81% lower risk of in-hospital mortality (1.9% vs 9.4%, odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.13-0.29, p < 0.001) and 19% lower risk of procedural-related complications (21.1% vs 24.8%, OR: 0.81, 95% CI: 0.70-0.94, p = 0.004 ) compared to those treated with CSD alone (figure 1). There were no significant differences in reoperation (2.6% vs 1.9%, OR: 1.38, 95% CI: 0.96-2.00, p = 0.09), all-cause inpatient readmission or emergency room (ER) visits (38.8% vs 37.3%, OR: 1.07, 95% CI: 0.95-1.21, p = 0.29 ), and SDH-related inpatient readmission or ER visits (7.2% vs 6.4%, OR: 1.14, 95% CI: 0.91-1.42, p = 0.26) within 1-year post intervention.Conclusions Among patients with traumatic SDH, adjunctive MMAe with CSD was associated with significantly lower inhospital mortality and proceduralrelated complication rates compared with CSD alone. Study results demonstrate that MMAe in conjunction with CSD may lead to meaningful improvement in patient outcomes versus CSD alone.Disclosures A. Rai: 2; C; Johnson & Johnson, Stryker. C. Kellner: 1; C; Integra LifeSciences, Penumbra, Viz.ai, Siemens, Medtronic, Longeviti, IRRAS, iCE Neurosystems, CVAID, EndoStream, and MicroTransponder. 2; C; Johnson & Johnson, Route 92 Medical. 6; C; Precision Recovery, Borealis, E8, Borvo, and METIS Innovative. Y. Rong: 5; C; Johnson & Johnson. R. Khanna: 5; C; Johnson & Johnson. E. Kottenmeier: 5; C; Johnson & Johnson. E. Rautela: 5; C; Johnson & Johnson. R. Grandhi: 2; C; Johnson & Johnson, Medtronic Neurovascular, Balt Neurovascular, and Stryker Neurovascular.Abstract E-090 Figure 1