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VA Medical Centers Designated for Surgical Complexity

Surgical team performs a transplant

The Department of Veterans Affairs (VA), the nation's largest health care system, has new measures in place to ensure that all inpatient surgeries are performed under the safest possible conditions at facilities with the resources to support them.

VA assigned each of its medical centers an inpatient "surgical complexity" level — complex, intermediate or standard.

The Veterans Health Administration (VHA) is the first hospital system to conduct a comprehensive quality review to determine what level of inpatient surgeries may be performed in each of its 110 surgery programs. The designations are based on facilities, equipment, workload, and staffing load.

Hospitals assigned a "complex" rating require special facilities, equipment and staff for difficult operations, such as cardiac surgery and craniotomies. Those with an "intermediate" rating may perform less complex surgeries, such as partial colon removal and complete joint replacement. Those with a "standard" rating may perform inpatient surgeries, such as hernia repair and ear, nose, and throat (ENT) surgeries. These measures were implemented May 7, 2010, per VHA Directive 2010-018: “Facility Infrastructure Requirements to Perform Standard, Intermediate, or Complex Surgical Procedures.”

Additionally, VA's 25 ambulatory surgery centers were assigned a surgical complexity level of either basic or advanced, based on the facility’s infrastructure. These measures were implemented October 14, 2011, per VHA Directive 2011-037, “Facility Infrastructure Requirements to Perform Invasive Procedures in an Ambulatory Surgery Center.”

VHA works to meet the individual needs of every Veteran: If a hospital cannot provide a certain type of therapy or treatment to a patient, it will transfer the Veteran to a facility that has these programs.

The VA health care system serves nearly 6 million Veterans each year and is the 2010 recipient of the leadership award of the American College of Medical Quality. For detailed information, see