VHA Operative Complexity - Veterans Health Administration
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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.

Inpatient and Ambulatory VHA surgery programs and their complexity designations
VHA Surgical Program LocationVeterans Integrated Service Network (VISN)Operative Complexity Designation
Birmingham, AL 7 Complex
Montgomery, AL 7 Standard
Fayetteville, AR 16 Intermediate
Little Rock, AR 16 Complex
Phoenix, AZ 18 Complex
Tucson, AZ 18 Complex
Fresno, CA 21 Intermediate
Martinez, CA 21 Ambulatory-Advanced
Sacramento, CA 21 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
Denver, CO 19 Complex
Grand Junction, CO 19 Standard
West Haven, CT 1 Complex
Washington, DC 5 Complex
Wilmington, DE 4 Intermediate
Bay Pines, FL 8 Complex
Cape Coral, FL 8 Ambulatory-Basic
Gainesville, FL 8 Complex
Lake City, FL 8 Ambulatory-Advanced
Miami, FL 8 Complex
Orlando, FL 8 Intermediate
Tampa, FL 8 Complex
West Palm Beach, FL 8 Intermediate
Augusta, GA 7 Complex
Atlanta, GA 7 Complex
Dublin, GA 7 Standard
Des Moines, IA 23 Intermediate
Iowa City, IA 23 Complex
Boise, ID 20 Intermediate
Danville, IL 11 Ambulatory-Basic
Chicago-Jesse Brown, IL 12 Complex
Hines, IL 12 Complex
North Chicago, IL 12 Intermediate
Marion, IL 15 Standard
Evansville, IN 15 Ambulatory-Basic
Fort Wayne, IN 11 Standard
Indianapolis, IN 11 Complex
Leavenworth, KS 15 Standard
Topeka, KS 15 Ambulatory-Basic
Wichita, KS 15 Intermediate
Lexington, KY 9 Complex
Louisville, KY 9 Complex
New Orleans, LA 16 Complex
Pineville, LA 16 Ambulatory-Advanced
Shreveport, LA 16 Complex
Boston-Jamaica Plain, MA 1 Ambulatory-Advanced
West Roxbury, MA 1 Complex
Baltimore, MD 5 Complex
Togus, ME 1 Intermediate
Ann Arbor, MI 11 Complex
Detroit, MI 11 Complex
Saginaw, MI 11 Ambulatory-Basic
Iron Mountain, MI 12 Ambulatory-Basic
Minneapolis, MN 23 Complex
St. Cloud, MN 23 Ambulatory-Basic
Columbia, MO 15 Complex
Kansas City, MO 15 Complex
St. Louis, MO 15 Complex
Biloxi, MS 16 Intermediate
Jackson, MS 16 Complex
Billings, MT 19 Ambulatory-Basic
Fort Harrison, MT 19 Standard
Asheville, NC 6 Complex
Charlotte, NC 6 Ambulatory-Basic
Durham, NC 6 Complex
Fayetteville, NC 6 Standard
Fayetteville-ASC, NC 6 Ambulatory-Basic
Kernersville, NC 6 Ambulatory-Advanced
Salisbury, NC 6 Intermediate
Fargo, ND 23 Intermediate
Omaha, NE 23 Complex
Manchester, NH 1 Ambulatory-Basic
East Orange, NJ 3 Complex
Albuquerque, NM 18 Complex
Reno, NV 21 Intermediate
Las Vegas, NV 22 Intermediate
Albany, NY 2 Complex
Buffalo, NY 2 Complex
Syracuse, NY 2 Complex
Bronx, NY 3 Complex
Brooklyn, NY 3 Complex
Northport, NY 3 Complex
New York, NY 3 Complex
Cincinnati, OH 10 Complex
Cleveland-ASC, OH 10 Ambulatory-Basic
Cleveland, OH 10 Complex
Columbus, OH 10 Ambulatory-Advanced
Dayton, OH 10 Intermediate
Muskogee, OK 16 Intermediate
Oklahoma City, OK 16 Complex
Eugene, OR 20 Ambulatory-Advanced
Portland, OR 20 Complex
Roseburg, OR 20 Ambulatory-Basic
Altoona, PA 4 Ambulatory-Basic
Erie, PA 4 Ambulatory-Advanced
Lebanon, PA 4 Intermediate
Philadelphia, PA 4 Complex
Pittsburgh, PA 4 Complex
Wilkes-Barre, PA 4 Intermediate
San Juan, PR 8 Complex
Providence, RI 1 Intermediate
Charleston, SC 7 Complex
Columbia, SC 7 Complex
Fort Meade, SD 23 Standard
Hot Springs, SD 23 Ambulatory-Basic
Sioux Falls, SD 23 Intermediate
Memphis, TN 9 Complex
Mountain Home, TN 9 Intermediate
Murfreesboro, TN 9 Ambulatory-Basic
Nashville, TN 9 Complex
Houston, TX 16 Complex
Dallas, TX 17 Complex
Harlingen, TX 17 Ambulatory-Basic
San Antonio, TX 17 Complex
Temple, TX 17 Complex
Amarillo, TX 18 Intermediate
El Paso, TX 18 Ambulatory-Basic
Salt Lake City, UT 19 Complex
Clarksburg, WV 4 Intermediate
Hampton, VA 6 Intermediate
Richmond, VA 6 Complex
Salem, VA 6 Intermediate
White River Junction, VT 1 Intermediate
Seattle, WA 20 Complex
Spokane, WA 20 Standard
Tacoma, WA 20 Ambulatory-Basic
Green Bay, WI 12 Ambulatory-Basic
Madison, WI 12 Complex
Milwaukee, WI 12 Complex
Martinsburg, WV 5 Intermediate
Beckley, WV 6 Standard
Huntington, WV 9 Complex
Cheyenne, WY 19 Standard

Table Data Updated: 9/30/2020

More Information about VHA Operative Complexity

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).