The Veterans Administration (VA) classifies the complexity of a surgical procedure using a scale from 1 to 5. The operative grade correlates with duration of the procedure, cost and complications.
Complexity
Example Surgical Procedure
Complexity
minimal
biopsy, debridement, hemorrhoidectomy, simple hernia
1.0 to 1.9
mild
gallbladder, exploratory laparotomy, major breast surgery, soft-tissue surgery
2.0 to 2.9
moderate
major biliary, gastric, colorectal surgery
3.0 to 3.9
significant
low anastomosis with pouch, esophagectomy
4.0 to 4.9
extreme
Whipple procedure, pelvic extenteration
5.0
A number of factors may increase the complexity of a procedure:
(1) emergency or urgency
(2) previous surgery with adhesions
(3) viscus rupture with infection
(4) comorbid conditions
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