Veterinary surgical decisions are often framed around whether a lesion can be removed or a procedure can be technically completed. That framing is insufficient when technical feasibility coexists with uncertain disease control, major functional loss, limited physiological reserve, substantial anesthetic risk, prolonged recovery, or owner and care-environment constraints. This original non-empirical article develops a multilevel surgical-selection framework that separates operability from appropriateness and organizes decision-making across anatomy, lesion biology, local-control expectations, functional consequences, patient reserve, perioperative risk, recovery burden, caregiver feasibility, and alternative treatment pathways. The framework treats these domains as analytically distinct but clinically interacting and emphasizes that some constraints may be noncompensatory: excellence in one domain cannot automatically offset unacceptable burden in another. It also treats surgical selection as revisable rather than fixed, allowing new intraoperative information, conversion, staged procedures, and postoperative outcomes to update the operative plan. The principal contribution is a proposed adjudication architecture rather than a validated score or prediction rule. It is intended to make the reasoning behind operative selection more explicit, auditable, and comparable across cases while preserving uncertainty and owner participation. The supporting evidence is heterogeneous, predominantly canine, and derived from disease-specific cohorts, peri-anesthetic studies, technical investigations, owner research, and measurement studies. Accordingly, the framework requires prospective multispecies and multicenter validation before it can be used as a formal clinical decision instrument.
