Authorized accreditors are the Joint Commission, the Accreditation Association for Ambulatory Health Care and the American Association for Accreditation of Ambulatory Surgery Facilities. Their classifications of surgical facilities, which denote levels of surgery and anesthesia provided, are not standardized.
The following Levels I-III refer to the complexity of surgeries, as used by some state medical boards, while Classes A-C refer to the level of anesthesia provided, as described by the American College of Surgeons in its “Guidelines for Optimal Ambulatory Surgical Care and Office-based Surgery.”
Level I. Minor surgical procedures performed under topical, local or infiltration block anesthesia not involving drug-induced alteration of consciousness, other than minimal sedation utilizing preoperative oral anxiolytic medications.
Class A. Provides for minor surgical procedures performed under topical and local infiltration blocks with or without oral or intramuscular preoperative sedation. Excluded are spinal, epidural, axillary, stellate ganglion block, regional blocks (such as interscalene), supraclavicular, infraclavicular and intravenous regional anesthesia.
Level II. Minor or major surgical procedures performed in conjunction with oral, parenteral or intravenous sedation or under analgesic or dissociative drugs.
Class B. Provides for minor or major surgical procedures performed in conjunction with oral, parenteral or intravenous sedation or under analgesic or dissociative drugs.
Level III. Surgical procedures that require deep sedation/analgesia, general anesthesia or major conduction blocks and support of vital bodily functions.
Class C. Provides for major surgical procedures that require general or regional block anesthesia and support of vital bodily function. (AAASF standards use a similar A, B, C, C-M classification, and specifically restrict the use of propofol to Class C facilities.)
