Title: Inappropriate surgeries in amyotrophic lateral sclerosis: evaluating trends
Additional authors (in order): Alexander Tomesch MS4, Nazan Aksan PhD, Ryan Lay MS4, Laurie Gutmann MD
Institution name, city, state, country of additional authors: University of Iowa, Iowa City, IA, USA
In a seminal paper published in 2006, Srinivasan et al noted that 61% of ALS patients underwent inappropriate surgeries prior to diagnosis. Since then, several papers have evaluated factors associated with surgeries and delay in ALS diagnosis. We conducted a chart review of ALS patients evaluated at our institution between 2000-2014 to look at the rate of inappropriate surgeries performed prior to and after 2006 to see if this rate is declining over time. Charts of 537 patients were coded for patient characteristics including site of disease onset (limb vs bulbar), sex, rural vs urban residency, comorbidities, and the year of symptom onset. Among patients with limb onset, the findings showed: 1) women experienced longer diagnostic delays than men (p=.021) but were similar to men in likelihood of surgeries (p=.128); 2) rural patients showed a trend toward shorter delays than urban patients (p=.054) but were more likely to get surgeries (p=.013); 3) comorbidities did not predict delay but increased the likelihood of surgeries (p=.019). Importantly, after 2006, the time from symptom onset to diagnosis of limb onset ALS shortened in general (p
