VHA Operative Complexity
The Department of Veterans Affairs (VA), the nation's largest health care system, has processes in place to ensure that all surgeries are performed under the safest possible conditions at facilities with the resources to support them.
The Veterans Health Administration (VHA) assigned each of its Inpatient surgical programs an "operative complexity" level of Standard, Intermediate, or Complex; and each of its Ambulatory (outpatient-only) surgery centers an operative complexity level of either Basic or Advanced. Learn more about what operative complexity means.
The VHA policy that governs operative complexity was expanded on May 13, 2019 to also include infrastructure requirements and complexity designations for non-surgical invasive procedures, in Directive 1220 Facility Procedure Complexity Designation Requirements to Perform Invasive Procedures In Any Clinical Setting (replacing Directives 2010-18 and 2011-037).
A listing of all Inpatient and Ambulatory VHA surgery programs and their complexity designations is below. The facility complexity listing below does not yet reflect the additional designations for non-surgical facilities. The list is sorted by state.
|VHA Surgical Program Location||Veterans Integrated Service Network (VISN)||Operative Complexity Designation|
|Little Rock, AR||16||Complex|
|Palo Alto, CA||21||Complex|
|San Francisco, CA||21||Complex|
|Loma Linda, CA||22||Complex|
|Long Beach, CA||22||Complex|
|San Diego, CA||22||Complex|
|West Los Angeles, CA||22||Complex|
|Grand Junction, CO||19||Standard|
|West Haven, CT||1||Complex|
|Bay Pines, FL||8||Complex|
|Cape Coral, FL||8||Ambulatory-Basic|
|Lake City, FL||8||Ambulatory-Advanced|
|West Palm Beach, FL||8||Intermediate|
|Des Moines, IA||23||Intermediate|
|Iowa City, IA||23||Complex|
|Chicago-Jesse Brown, IL||12||Complex|
|North Chicago, IL||12||Intermediate|
|Fort Wayne, IN||11||Standard|
|New Orleans, LA||16||Complex|
|Boston-Jamaica Plain, MA||1||Ambulatory-Advanced|
|West Roxbury, MA||1||Complex|
|Ann Arbor, MI||11||Complex|
|Iron Mountain, MI||12||Ambulatory-Basic|
|St. Cloud, MN||23||Ambulatory-Basic|
|Kansas City, MO||15||Complex|
|St. Louis, MO||15||Complex|
|Fort Harrison, MT||19||Standard|
|East Orange, NJ||3||Complex|
|Las Vegas, NV||22||Intermediate|
|New York, NY||3||Complex|
|Oklahoma City, OK||16||Complex|
|San Juan, PR||8||Complex|
|Fort Meade, SD||23||Standard|
|Hot Springs, SD||23||Ambulatory-Basic|
|Sioux Falls, SD||23||Intermediate|
|Mountain Home, TN||9||Intermediate|
|San Antonio, TX||17||Complex|
|El Paso, TX||18||Ambulatory-Basic|
|Salt Lake City, UT||19||Complex|
|White River Junction, VT||1||Intermediate|
|Green Bay, WI||12||Ambulatory-Basic|
Table Data Updated: 4/29/2020
VHA “operative complexity” establishes the infrastructure that is required at a VHA facility in relationship to the complexity of the surgical procedures being performed. This requirement ensures that the scope of the surgical procedure is within the capability of the facility. This requirement makes sure that surgeries are performed under the safest possible conditions.
A facility infrastructure refers to: diagnostic evaluation; consultation; surgical physician staffing; operating room staffing, instruments, equipment, coverage, and radiology; anesthesia services; post anesthesia care unit; intensive care unit; ward; supply, processing, and distribution; and other support services related to a surgical procedure.
When occurring in an Inpatient surgical program, each surgical procedure is assigned an operative complexity designation of Standard, Intermediate, or Complex.
- Example of a Standard procedure is an appendectomy (removal of the appendix).
- Example of an Intermediate procedure is a shoulder joint reconstruction.
- Example of a Complex procedure is a coronary artery bypass graft (CABG), a type of open heart surgery.
When occurring in an Ambulatory surgical program, each surgical procedure is assigned an operative complexity designation of either Basic or Advanced.
- Example of a Basic procedure is surgical removal of a skin cancer.
- Example of an Advanced procedure is laparoscopic cholecystectomy (removal of the gallbladder).