VA limits surgeries at Spokane, other hospitals

Spokane Veterans Affairs Medical Center no longer will perform certain types of surgeries after a systemwide review prompted by surgical deaths at a VA hospital in Illinois. Under a new system, the VA has given each hospital a “surgical complexity” level. Because of that, hospitals in at least five states will now only perform less-complicated surgeries. The hospitals are in Alexandria, La.; Beckley, W.Va.; Fayetteville, N.C.; Danville, Ill.; and Spokane. The change affects only about 6.5 percent of the surgeries performed at Spokane VA, said Dr. Jacy Ryan, a cardiologist at the hospital. “There were no mal-occurrences at Spokane VA that precipitated any of this,” Ryan said. A nationwide initiative prompted by surgical deaths in 2007 at the VA hospital in Marion, Ill., looked at the types of surgeries performed and classified them as standard, intermediate or complex, Ryan said. An advisory panel decided what VA infrastructure, including equipment and staff, was necessary to support those surgeries. “They looked at possible complications, no matter how remote,” Ryan said. As a result, the five hospitals will be limited to standard surgeries for such conditions as cataracts, hernias and laparoscopic procedures. Spokane VA will no longer perform intermediate surgeries such as colon resection, nephrectomies or prostatectomies. More complicated surgeries, now rated “complex,” have not historically been performed at the Spokane VA. Patients requiring intermediate surgeries will be referred to either another VA hospital in the region or a local provider depending on urgency and the patient’s ability to travel, Ryan said. “This will ensure patient safety and allow us to increase the number of standard procedures we perform,” said Perry Danner, associate director at Spokane VA. The VA provided more than 357,000 inpatient surgeries last year, including 955 in Spokane. The department anticipates that only 0.1 percent of surgeries categorized as “intermediate” or “complex” would now be referred to other providers as a result of the change announced Thursday.