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NAPLES, Italy — Five Veterans Affairs hospitals can no longer perform certain surgeries after the VA determined the facilities were not properly equipped to carry out more complex procedures.

VA hospitals in Alexandria, La.; Beckley, W.Va.; Fayetteville, N.C.; Illiana at Danville, Ill.; and Spokane, Wash., are now authorized to perform only standard inpatient surgeries — the lowest rating assigned under the agency’s new Surgical Complexity Initiative.

The initiative is the result of a two-year nationwide review of inpatient care at VA facilities, the agency announced last week. Under the initiative, each of the VA’s stateside surgical hospitals now carry a designation of standard, intermediate or complex, which defines the types of surgery each is authorized to perform.

Hospitals with a rating of complex can carry out intricate procedures such as craniotomies, cardiac and pancreatic surgery. An intermediate rating means a hospital can perform such surgeries as joint replacements and abdominal procedures. Hospitals with a standard rating are authorized to provide only simple inpatient procedures such as hernia repair, urologic procedures and ear, nose and throat surgery.

"Those five facilities were given standard designations based on infrastructure, workload and staffing level," said VA spokesman Drew Brookie.

Nationwide, the VA provided more than 357,000 inpatient surgeries last year. Overall, the agency provides health care to 6 million veterans annually, according to the agency.

VA officials spent nine months reviewing each of its 112 surgical facilities around the country to determine the appropriate surgical complexity level. While the review targeted inpatient surgeries, the agency said it will expand the complexity ratings to include outpatient procedures in the future.

"VA began this major undertaking … to close and prevent gaps in surgical care," Dr. Robert Petzel, VA’s undersecretary of health, said in a statement released last week.

The review began in 2007 after conditions at the VA Medical Center in Marion, Ill., prompted the Office of Healthcare Inspections to investigate why that hospital’s mortality rate was more than four times higher than expected between October 2006 and March 2007, according to a report released by the agency’s inspector general.

A report from the VA inspector general, based on the death of 29 veterans who had surgery at the Illinois hospital in 2007, said the inpatient surgical specialty unit at the Marion facility "was in disarray" and noted poor quality of care before, during and after surgery. The report also noted poor care in non-fatal cases. While the Marion facility remains open, it is limited to providing outpatient care only.

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