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Understand Smoking & Elective Surgical Procedures Guidelines

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What Does the Oregon Health Authority (OHA) Consider an Elective Surgical Procedure?

The OHA’s Ancillary Guideline A4 defines elective surgical procedures as those which are flexible in their scheduling because they do not pose an imminent threat nor require immediate attention within one month.

Exceptions to this guideline are reproductive surgeries (i.e. tubal ligations), active cancer-related surgeries and diagnostic procedures (i.e. hysteroscopy, excisional biopsy).

InterCommunity Health Network Coordinated Care Organization (IHN-CCO) Members Must Stop Smoking Prior to Elective Surgery

A member who is smoking combustible products (i.e. cigarettes, cigars, pipe tobacco) may be referred to their primary care provider for assistance with smoking cessation. Nicotine replacement options could be considered. Acupuncture is also a covered benefit and may help the member quit smoking (IHN-CCO members are eligible for a small number of acupuncture visits for smoking cessation).

Vaping, Nicotine Replacement Patches or E-cigarettes Are Allowed Four Weeks Prior to Surgery

Only combustible smoking products need to be stopped four weeks prior to surgery.

What Documentation is Needed to Confirm Smoking Cessation?

  1. The member needs documentation of their quit date or the date they switched to a nicotine replacement product.
  2. The member must have confirmed lab result evidence that they are smoke free.

    a)  If the member states they have quit smoking and are not using any nicotine products, a negative urine cotinine levels test must confirm their attestation.

    b)  If the member is using nicotine replacement therapy to stop smoking combustible smoking products, then anabasine or anatabine testing or exhaled carbon monoxide testing would be required (as cotinine levels may be positive when using nicotine replacement therapy).

Procedures That Have a Longer Cessation Period or Requirement

“Certain procedures, such as lung volume reduction surgery, bariatric surgery, erectile dysfunction surgery and spinal fusion have six-month tobacco abstinence requirements.” See Guideline Notes 8, 100, 112 and 159.” (Ancillary Guideline A4)

An elective surgical procedure prior authorization should be submitted, along with the confirmed laboratory testing evidence.

Reference:  Ancillary Guideline A4, Smoking Cessation and Elective Procedures, Oregon Health Authority: Prioritized List Extracted from the Aug. 14, 2020, Prioritized List