Who determines the classification of work for surgery, such as the American Medical Association (AMA) and other specialty-specific organizations like the American College of Surgeons (ACS)?

Organizations Responsible for Surgical Work Classifications

The American College of Surgeons (ACS) is the primary organization responsible for establishing classifications of work for surgery, along with specialty-specific organizations like the American Academy of Orthopaedic Surgeons (AAOS) that develop their own classification systems for their respective specialties. 1

Major Organizations and Their Classification Systems

American College of Surgeons (ACS)

• Develops comprehensive triage criteria and surgical prioritization systems 1
• Created the Elective Surgery Acuity Scale that classifies procedures into high, intermediate, and low acuity 1
• Distinguishes pandemic phases based on hospital resource availability and patient burden 1
• Establishes quality improvement programs that influence surgical classification standards 2
• Has over 80,000 members worldwide and serves as a leading voice in surgical standards 3

American Academy of Orthopaedic Surgeons (AAOS)

• Develops Appropriate Use Criteria (AUC) for various surgical procedures 1, 4
• Uses a systematic approach involving three independent panels:
  1. Writing Panel: Develops patient scenarios and treatment options
  2. Review Panel: Reviews materials to ensure they represent common clinical scenarios
  3. Voting Panel: Rates appropriateness of treatments using a 9-point scale 1
• Classifications designate treatments as:
  • Appropriate (median rating 7-9)
  • May Be Appropriate (median rating 4-6)
  • Rarely Appropriate (median rating 1-3) 1

Other Significant Organizations

• British National Health Service (NHS): Provides four-level surgical priority classification system 1
• European Society for Medical Oncology (ESMO): Identifies three levels of surgical priority (high, medium, low) 1
• American Society of Anesthesiologists (ASA): Provides patient status classification that influences surgical risk assessment 5
• American Medical Association (AMA): Contributes to risk stratification systems used in surgical planning 5

Classification Development Process

The development of surgical classifications typically follows this process:

1. Evidence Collection: Organizations conduct systematic literature reviews to gather evidence 1
2. Expert Panel Formation: Multidisciplinary panels of specialists and non-specialists are convened 1
3. Scenario Development: Clinical scenarios representing common patient presentations are created 1
4. Treatment Rating: Panels rate the appropriateness of various treatments for each scenario 1
5. Guideline Publication: Final classifications are published as guidelines for clinical practice 1

Impact of Classifications

These classification systems serve several critical purposes:

• Guide surgical decision-making and prioritization 1
• Standardize reporting across healthcare systems 1
• Improve quality of care and patient outcomes 1
• Provide a foundation for performance measures and quality improvement 1
• Help determine resource allocation, especially during crises 1

Clinical Application

Surgeons use these classification systems to:

• Determine surgical priority based on patient condition and urgency 1
• Assess appropriateness of specific procedures for individual patients 1
• Standardize documentation of surgical procedures 1
• Guide postoperative care based on procedure complexity 5

These classification systems are dynamic and evolve based on new evidence, changing practice patterns, and emerging healthcare challenges, as demonstrated by the ACS's rapid development of surgical triage criteria during the COVID-19 pandemic 1.