General surgery

Bariatric surgery

Bariatrics is a branch of medicine that specialises in the causes, prevention, and treatment of obesity. Bariatric surgery is a form of surgery that is designed to facilitate weight loss. The terms weight loss surgery, bariatric surgery and metabolic surgery are used interchangeably.

Referral process by district for bariatric surgery

Wellington, Hutt and Kapiti, Wairarapa, Whanganui and Hawke's Bay

The Central Region Metabolic and Bariatric Service (CRMBS) provides publicly funded weight loss surgery for patients residing in:

Wellington, Hutt and Kapiti
Wairarapa
Whanganui
Hawke's Bay

People may be eligible for the surgery if they:

weigh less than 160kg and their Body Mass Index (BMI) is greater than 35 and less than 55.
are being treated for obesity related conditions such as diabetes, sleep apnoea, high blood pressure (hypertension), high amounts of cholesterol in the blood (hypercholesterolaemia), infertility, arthritis.
have not smoked cigarettes or used nicotine replacement products for at least 6 months.

Referral process

Read the referral process for bariatric surgery at CRMBS [PDF, 86 KB]

Bariatric surgery health questionnaire [PDF, 107 KB]

Resources

Bariatric Surgery — a guide for patients [PDF, 99 KB]

Considering Bariatric Surgery — Patient information [PDF, 92 KB]

Metabolic and bariatric — Wellington, Hutt and Kapiti — Health New Zealand | Te Whatu Ora (external link)

Contact us

The CRMBS is based at Wellington Regional Hospital.

Email: opdbarclinic@ccdhb.org.nz

Bay of Plenty

Find the referral acceptance and access criteria for general surgery in the Bay of Plenty.

Referral acceptance

General surgery referrals are prioritised by senior medical officers based on the information contained within. Additional information should be attached where available. The prioritisation tool used to grade referrals can be found below under access criteria.

Skin lesion referrals are to be referred via the PHO skin lesion service in the first instance where they will be prioritised.
Only hospital grade skin lesions referred from the PHO will be accepted at Tauranga and Whakatane hospitals.
All hospital grade skin lesion referrals from the PHO will be accepted with a wait time of up to 4 months.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Referral acceptance is a follows:

First specialist assessments
Waiting priority 1	Accepted
Waiting priority 2A	Accepted
Waiting priority 2B	Accepted
Waiting priority 3	Declined
Waiting priority 3S	Declined
Waiting priority 4	Declined
Breast
Waiting priority 1	Accepted
Waiting priority 2	Accepted
Waiting priority 3	Accepted
Waiting priority 4	Declined

At first specialist assessments (FSA), patients are assessed by a specialist and if surgery is required, patients are then prioritised using the national general surgery CPAC tool. A 0-100 score is allocated to each patient.

Prior to acceptance for surgery, patients are assessed in an anaesthetic pre-assessment clinic to ensure they are fit for surgery.

All patients accepted for surgery will be treated within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Surgery acceptance is as follows:

CPAC 65+	Accepted
CPAC 64 and below	Declined

Access criteria

Bariatric Surgery - The national board bariatric surgery prioritisation system [PDF, 116 KB]

Category	Criteria	Examples (not an exhaustive list)
1. Immediate	High risk life or limb Major deterioration or exacerbation with delay Otherwise requiring acute admission Pressing other or "psychosocial" factors	Symptomatic or obstructing colon cancer Vomiting and gastric outlet obstruction Breast cancer/young distraught patient Diabetic foot sepsis or gangrene Obstructive jaundice Crescendo TIA or carotid stenosis
2A. Urgent	Proven or likely malignancy (not BCC) Alarm symptoms or signs malignancy Frequent severe painful/disabling conditions Significant short to medium term risks	Hx severe complicated cholelithiasis e.g. biliary pancreatitis Hx obstructed inguinal hernia Palpable rectal mass Suspicious breast lump FNA +ve ear and neck lump Elderly iron deficiency anaemia Ischemic rest pain or nocturnal leg hanging Large AAA
2B. Semi-urgent	Occasional to moderate pain only Persisting minor disability or loss of function Non-specific symptoms or signs +/- low risk demographic requiring investigation Low grade sepsis	Mild symptoms cholelithiasis Fistula-in-ano IBS symptoms/young adult GORD/dyspepsia/young adult Anal outlet bleeding/young adult Venous ulcer disease Chronic pilonidal disease Intermittent claudication Non-specific breast symptoms or mastalgia Re-excision melanoma surgery
3. Routine (Not accepted)	Minimal functional impairment Likely benign Chronic or stable Little short to medium term risk Significant family history	Asymptomatic carotid disease Non-specific vascular symptoms FAP screening Asymptomatic hyperPTHism Haemorrhoids Gynaecomastia Small AAA Epitheliomata Chronic goitre BCC/SCC if surgery likely to be more than "minor"
3A. Routine (Not accepted)	Same as Grade 3 but likely to require surgery	-
4. Routine (Not accepted)	Minor or nil loss of function Minor or nil discomfort Benign or low grade malignant Self-limiting Low risk	Uncomplicated hernia Lipoma Seb cyst Cosmetic (scars or tattoos) Ganglion Low risk "screening" Skin tags Minor BCC/SCC surgery

Notes:

Clinical priority criteria is a guide rather than exhaustive, complete or exclusory. The grading surgeon may well take into account other factors such as comorbidity, age, history and previous investigation results to help prioritise a particular referral. The examples similarly are not necessarily prescriptive e.g., an elderly patient with severe ischemic heart disease and claudication may have a different priority from a postman with similar symptoms.
Simple skin cancers are not considered urgent malignancies.
Varicose veins if meet primary care management guidelines.
The waiting time criteria are to be seen as a guide to maximum wait - many 2As and 2Bs will be seen sooner rather than at the maximum wait time. If patients cannot be seen within time, then the referrer will be notified by administrative staff.

Clinical pathway guidance for bariatric surgery

Bay of Plenty

Breast cancer surveillance recommendations

Health New Zealand Bay of Plenty recommendations for breast imaging are related to breast cancer screening and management.

Please note, practice varies from region to region and there are no national guidelines.

Screening imaging (asymptomatic patient) – for those requiring additional screening due to family history

Start mammograms 10 years earlier than the youngest affected individual or from 35 years old, whichever comes first. The addition of ultrasound will be at the discretion of the radiologist but may be indicated if there is significantly high breast density.
Before the age of 40 years is generally only required for those with an assessment tool confirmed with high risk family history – this may require referral to genetic services or the breast clinic to consider the use of annual breast MRI.
From 70 to 80 years old, screening mammograms can be reduced to every 2 years if the patient remains well.
For those over 80 years old, continue screening every 2 years only if physically well and would have treatment for breast cancer.
For those with a family history requiring additional screening, please complete details of affected family member as fully as possible.

Recommendations are based on EviQ guidelines for breast screening for patients with a strong family history. This is a good source for imaging guidelines: