Excluded Procedures Outpatient Referrals

While the WA Health Excluded Procedures precludes procedures performed for cosmetic or other non-medical reasons, procedures which meet an identified clinical need to improve the health of the patient may be undertaken in public hospitals. To avoid patients unnecessarily waiting for and attending appointments in cases where surgery cannot be offered at Royal Perth Hospital, referral criteria have been established for Abdominal lipectomy, Breast reduction, Blepharoplasty, Male circumcision, Rhinoplasty and Varicose veins.

For more information read the WA Health Elective Surgery Access and Waiting List Management Policy.

The referral criteria for each of the six WA Health excluded procedures are as follow:

1. Procedural specific referral criteria for abdominal lipectomy (abdominoplasty)

Specialty: Plastic surgery

Criteria for specialist referral via CRS

All referrals must provide evidence of the following 4 criteria:

  1. Non-smoker
  2. BMI < 30Kg/m2
  3. Patient’s weight has remained stable (+/- 5 Kg) for a period of 12 months
  4. If patient has chronic condition which may significantly impact on their surgical or anaesthetic risk (e.g. Type 2 diabetes), there is documented evidence of that their condition is well controlled.

Mandatory Information required for referral

All referrals must include detailed description of the associated physical and psychological functioning deficits in AT LEAST ONE of the following 6 criteria as appropriate:

  1. The abdominal apron (overhang) descends beneath the symphysis pubis and partially obscures the genitalia and bilateral groin creases AND/OR
  2. There is documented evidence of this skin fold causing in intertrigo, cellulitis, folliculitis, panniculitis, skin ulceration, subcutaneous abscesses, fungal infections or skin necrosis. These conditions must have been refractory from appropriate medical therapy for a period of at least six months AND/OR
  3. The patient demonstrates functional restrictions in their ability to walk and ambulate due to the size of panniculus AND/OR
  4. The patient has a significant scars on the abdomen which may have associated with hernia or pain which are physically distressing and/or cause significant contour defects which present difficulties with hygiene and infection risk OR
  5. Patients have problems associated with poorly fitting colostomy bags which may be improved with abdominal recontouring such as abdominoplasty OR
  6. Indicated as part of a hernia repair or other abdominal wall surgical procedure.
2. Procedural specific referral criteria for breast reduction

Specialty: Plastic surgery

Criteria for specialist referral via CRS

All referrals must provide evidence of the following 5 criteria:

  1. Non-smoker
  2. BMI < 30Kg/m2
  3. Patient’s weight has remained stable (+/- 5 Kg) for a period of 12 months
  4. If patient has chronic condition which may significantly impact on their surgical or anaesthetic risk (e.g. Type 2 diabetes), there is documented evidence of that their condition is well controlled.
  5. It is not performed as part of cancer treatment

Mandatory Information required for referral

All referrals must include detailed description of the associated physical and psychological functioning deficits in AT LEAST ONE of the following 8 criteria as appropriate:

  1. Demonstrable recurrent skin irritations, intertrigo in the inframammary fold and rashes that have been resistant to medical management with topical treatments and antibiotics over a six month period AND/OR
  2. Demonstrable indentations of the shoulders from the bra straps that support heavy pendulous breasts AND/OR
  3. Acquired thoracic kyphosis AND/OR
  4. Chronic breast pain, headache, paraesthesia of the upper extremity AND/OR
  5. Congenital / traumatic or post-surgical breast deformity or asymmetry of greater than 10% AND/OR
  6. The nipple areolar complex sits below the inframammary crease when the breast is unsupported AND/OR
  7. The patient’s breast size limits physical activity AND/OR
  8. The patient is emotionally and socially bothered with large breasts with resultant low self-esteem and episodes of documented depression.

Note: The above criteria must also be fulfilled by those patients who have achieved massive weight loss following bariatric surgery, or diet and exercise alone.

3. Procedural specific referral criteria for blepharoplasty

Specialty: Ophthalmology

Criteria for specialist referral via CRS

  • It is required as a reconstructive surgery OR
  • It is for skin redundancy if it is significantly affecting the upper visual field as indicated on visual field analysis.

Mandatory Information required for referral

  • Documented evidence of visual field analysis is performed by an optometrist or ophthalmologist.
4. Procedural specific referral criteria for rhinoplasty

Specialty: Ear, Nose and Throat

Criteria for specialist referral via CRS

  • It is required when patient has significant deformity AND
  • Surgery is / may be indicated due to disease, trauma or congenital conditions.

Mandatory Information required for referral

  • Referral must specify the indication for the procedure.
5. Procedural specific referral criteria for male circumcision

Specialty: Urology

Criteria for specialist referral via CRS

It is required for medical reasons namely:

  • Phimosis AND/OR
  • Paraphimosis AND/OR
  • Balanitis.

Mandatory Information required for referral

  • Referral must specify the indication for the procedure.
6. Procedural specific referral criteria for varicose veins

Specialty: Vascular surgery

Criteria for specialist referral via CRS

Patient had previous unsuccessful conservative GP management including:

  • 3 months of using compression therapy AND
  • Ongoing symptoms despite the above treatment of sufficient severity to warrant referral to a vascular surgeon.

Mandatory Information required for referral

  • All referrals must include detailed description of the signs and symptoms of venous severity and documentation of conservative management trialled to date.