Compliance with melanoma treatment guidelines in a community teaching hospital: time trends and other variables.

BACKGROUND: Variation in the surgical treatment of melanoma occurs despite efforts to standardize care. This may lead to morbidity, inaccurate staging, and poor outcomes, or it may be cost ineffective. The purpose of our study was to evaluate our institutional compliance with National Comprehensive Cancer Network (NCCN) melanoma treatment guidelines. METHODS: We studied 252 clinically node-negative melanoma patients identified from our cancer registry. Treatment data were confirmed by individual review of pathology and operative reports. RESULTS: Documented margins of excision conformed to NCCN guidelines in 87% of Tis-T1 tumors and 60% of T2-T4 tumors. Lymph node staging was performed in 11% of T1a, 64% of T1b, 74% of T2, 63% of T3, and 47% of T4 patients. Treatment by a surgical oncologist achieved margin and lymph node compliance in 95% and 92% of cases versus other practitioners in 38% and 67%, respectively (P < .0001). Documented compliance with margin guidelines improved from 46% to 73% for the years 1995 to 1999 versus 2000 to 2004 (P < .0001) and for lymph node staging and treatment from 74% to 84% (P = .04). Other factors associated with greater adherence to NCCN guidelines were patient age <80 years, upper extremity tumors, and thinner tumors (all P < .05). CONCLUSIONS: Our data suggest that our compliance with NCCN melanoma treatment guidelines was suboptimal. Treatment directed by a surgical oncologist showed the highest rate of adherence to national standards. Further investigation is needed to determine the effect of this on patient outcomes and how best to provide high-quality care to the greatest number of melanoma patients.

Trends in bariatric surgery for morbid obesity in Wisconsin.

BACKGROUND: Obesity is a national epidemic with rates in Wisconsin and the United States doubling over the past decade. Research of available treatments for morbid obesity (body mass index > or = 40 kg/m2) suggests that bariatric surgery may be the only modality that provides any significant long term weight loss. METHODS: Using the data from Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, we analyzed self-reported information on body weight and height among adults in Wisconsin. We used the WITHIN database for inpatient hospitalization and surgeries in Wisconsin to evaluate trends in gastric bypass surgery. Finally, we surveyed bariatric surgeons in Wisconsin to assess trends in bariatric surgery in the state. RESULTS: In Wisconsin, the percentage of the adults considered to be obese increased from 11% in 1990 to 22% in 2001. In 1999-2001, approximately 80,000 adults (2% of the population) were morbidly obese. The number of gastric bypass surgeries performed in Wisconsin more than doubled in 1 year, from 182 in 2001 to 426 in 2002. According to bariatric surgeons, gastric bypass accounts for approximately 90% of bariatric surgeries performed in Wisconsin. Thus, in 2002, there was roughly 1 bariatric surgery for every 200 morbidly obese Wisconsin adults. Most (84%) bariatric surgeons are planning to increase the number of procedures they perform, and 24% plan on adding an additional bariatric surgeon to their group. SUMMARY: Bariatric surgery rates are increasing in Wisconsin, yet the demand for surgery far exceeds current capacity of surgeons in the state.