Surgical operations and procedures statistics

Data extracted in September 2017. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: October 2018.

This article presents an overview of European Union (EU) statistics related to surgical operations and procedures. It provides information for a selection of the most common surgical operations and procedures.

This article is one of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on health statistics.

Table 1: Surgical operations and procedures performed in hospitals — top 10 procedures group 1, 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 1: Cataract surgery, 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 2: Colonoscopy with or without biopsy, 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Table 2: Surgical operations and procedures performed in hospitals — top 10 procedures group 2, 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 3: Caesarian section, 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Table 3: Selected high growth procedures performed in hospitals, 2010 and 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Table 4: Selected large decline procedures performed in hospitals, 2010 and 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 4: Share of in-patient procedures for cataract surgery, 2010 and 2015
(%)
Source: Eurostat (hlth_co_proc2)

Main statistical findings

Number of surgical operations and procedures

The two most common procedures in the EU were colonoscopies and cataract surgery

Tables 1 and 2 indicate how frequently a selection of the most common surgical operations and procedures were conducted in 2015; in both tables the data are presented relative to the size of the population. For several of these operations and procedures, such as appendectomies, information is given on the frequency with which these are carried out laparoscopically, in other words, using minimally invasive surgery (this technique involves performing an operation through only a small incision in the body and is also known as keyhole surgery), as well as a total figure.

Cataract surgery (ICD-9-CM codes 13.1-13.8), the extraction of the lens from an eye, was conducted 4.2 million times across the EU Member States (Belgium 2014 data, excluding Greece and the Netherlands; Latvia in-patients only), making this one of the two most common of the surgical operations and procedures presented in this article. In Germany, Sweden, Finland, Malta, the Czech Republic, Luxembourg, Estonia, France, Austria and Portugal, cataract surgery was performed 1.0 thousand times or more per 100 000 inhabitants in 2015, while Belgium (2014) and Liechtenstein (2013) also had values over 1.0 thousand per 100 000 inhabitants. By contrast, cataract surgery was performed fewer than 300 times per 100 000 inhabitants in Cyprus, Ireland, Slovakia and Latvia (in-patients only); this was also the case in Switzerland and the former Yugoslav Republic of Macedonia.

The second of the most common types of surgical operations and procedures was a colonoscopy with or without a biopsy (ICD-9-CM codes 45.22–45.25, 45.42 and 45.43), a procedure to examine the inside of the colon (large intestine or large bowel) with a camera. Relatively high frequencies for this procedure were recorded in Sweden, Luxembourg, the United Kingdom, Ireland, Malta, Belgium (2014 data), Croatia and Denmark, all over 1 000 per 100 000 inhabitants. In the remaining EU Member States for which data are available, the frequency of colonoscopies ranged from 208 to 813 per 100 000 inhabitants, with Cyprus, Slovenia, Finland and Hungary below this range.

Other common procedures include diagnostic bronchoscopies (an examination of the throat, larynx , trachea and lower airways) with or without a biopsy (ICD-9-CM codes 33.21-33.24 and 33.27) and transluminal coronary angioplasties (the opening up of blocked coronary arteries; ICD-9-CM codes 36.01, 36.02 and 36.05). The frequency of diagnostic bronchoscopies in 2015 reached 607 per 100 000 inhabitants in Latvia (in-patients only) and 588 per 100 000 inhabitants in Croatia while it was above 400 per 100 000 inhabitants in Germany. Among the remaining EU Member States for which data are available the frequency was in the range of 82-307 per 100 000 inhabitants, with Malta, Finland and Cyprus below this range. In 2015, transluminal coronary angioplasties were most common in Germany where they were performed on average 393 times per 100 000 inhabitants. They were conducted between 190 and 315 times per 100 000 inhabitants in most of the remaining Member States for which data are available, with Luxembourg, Cyprus, Ireland, the United Kingdom, Spain, Portugal and Romania below this range.

In general, the frequency of appendectomies (ICD-9-CM codes 47.0 and 47.1) varied less between the EU Member States than did other procedures presented in Tables 1 and 2. Nevertheless, the frequency of laparoscopic appendectomies (in other words, keyhole surgery to remove the infected appendix) was notably higher in Germany, Belgium (2014 data), Ireland and Denmark than in the other EU Member States, while it was lowest in Cyprus. The share of appendectomies that were performed laparoscopically varied greatly, from around 10 % of the total number of these procedures in Romania, and less than three quarters in most Member States, to more than four fifths in Germany, Belgium (2014 data) and Denmark. By contrast, the vast majority of cholecystectomies (removal of the gall bladder; ICD-9-CM codes 51.22 and 51.23) were performed laparoscopically, their share ranging from 78 % in Romania to 93 % in Denmark.

Other common procedures performed within the EU included repairs of inguinal hernias (ICD-9-CM codes 53.0 and 53.1) and hysterectomies (ICD-9-CM codes 68.3-68.7 and 68.9). Repairs of inguinal hernia (which involves covering the hernia defect with mesh from within the abdomen in order to patch it) were typically undertaken between 150 and 240 times per 100 000 inhabitants in 2015, with Austria and Malta reporting higher frequencies and the United Kingdom, Romania, Cyprus and Ireland lower frequencies. In Germany, a majority (58 %) of these repairs were undertaken laparoscopically, with this share dropping below 47 % in all of the remaining EU Member States for which data are available; the share was below 10 % in nine of the EU Member States and below 3 % in Italy, Portugal and Belgium (2014 data). Hysterectomies (the removal of all or part of the uterus) were most frequently performed in Lithuania (151 per 100 000 inhabitants), while they were least common in Denmark (13 per 100 000 inhabitants). More than half of all hysterectomies in Finland, Poland, the Czech Republic and Estonia were performed laparoscopically, a share that fell to just under half in Slovakia (in-patients only), between two fifths and a half in Belgium (2014 data), to around one third in Austria, France, Germany and Lithuania, to around one quarter in Sweden, Italy and the United Kingdom, and less than one quarter elsewhere.

At least 1.36 million caesarean sections performed in the EU

Another common procedure was caesarean section (ICD-9-CM codes 74.0-74.2, 74.4 and 74.99), in other words, the delivery of one or more babies through an incision in a mother’s abdomen and uterus. In 2015, this procedure was performed 1.36 million times in the EU (2014 data for Belgium; no data for Greece and the Netherlands; note that data for Portugal and Slovakia only cover in-patients). More than 220 thousand caesarean sections were performed in Germany, while just over 200 thousand were performed in the United Kingdom and over 170 thousand in Italy; in France, Poland and Spain there were also more than 100 thousand caesarean sections performed. In most of the EU Member States, between 200 and 400 caesarean sections were performed per 100 000 inhabitants, with this procedure more frequent in Ireland, Romania and Cyprus, and less frequent in Estonia, Croatia and Finland.

Hip replacements (ICD-9-CM codes 81.51-81.53) were performed nearly 300 times per 100 000 inhabitants in Germany and 271 times per 100 000 inhabitants in Austria; these were the highest frequencies among those EU Member States for which data are available.

Increasing and decreasing surgical operations and procedures

Large increases reported for appendectomies and hysterectomies performed using keyhole surgery

A selection of surgical operations and procedures which have become more frequent (during the period 2010-2015) is presented in Table 3; four of these concern laparoscopic techniques. The most rapid increases were observed for cochlear implantations (implanting an electronic medical device that replaces the function of the damaged inner ear) and laparoscopic hysterectomies.

Laparoscopic appendectomy (in other words, keyhole surgery to remove the infected appendix) was the most common operation among the five procedures shown in Table 3. Among the 18 EU Member States for which data are available for 2010 and 2015, all reported an increase in this procedure, the only exception being Belgium (for the period 2010-2014) where the frequency fell only very slightly. Seven Member States reported the frequency of this procedure more than doubling, the highest increases were reported by Slovenia, Finland and Lithuania.

17 out of 18 EU Member States for which data are available for 2010 and 2015 reported an increase in the number of laparoscopic hysterectomies (ICD-9-CM (2006) codes 68.31, 68.41, 68.51, 68.61 and 68.71), the exception was Slovenia which reported a slight fall in frequency. Four Member States reported the frequency of this procedure more than tripling, with particularly high increases in Romania and Hungary.

Between 2010 and 2015, the frequency of laparoscopic repair of inguinal hernia increased in 13 of the 16 EU Member States for which data are available. Six Member States reported the frequency of this procedure more than doubling, among them four more than tripling; the highest increases were reported by Slovenia and Portugal.

Although the absolute number of cochlear implantations remained relatively low, there was a widespread increase in this procedure. Among the 13 EU Member States for which data are available, only Lithuania reported a decrease in the frequency of this procedure, while the frequency of operations involving cochlear implants more than doubled in Ireland, Finland and Hungary and more than quadrupled in Slovenia.

The frequency of laparoscopic colectomy (part of ICD-9-CM codes 45.7-45.8), in other words, keyhole surgery to remove part of the large intestine, increased between 2010 and 2015 in all 10 EU Member States for which data are available except for Romania where this procedure was not conducted. The frequency of this operation almost doubled in Denmark and Spain (note there was a change of definition in Spain between 2010 and 2015), and nearly tripled in Sweden.

Tonsillectomies and hysterectomies, both relatively common procedures, were performed with a decreasing frequency

A selection of surgical operations and procedures which have become less common is presented in Table 4, two of which concern bypass surgery. Based on data for the 14 EU Member States for which data are available, there were nine Member States where there were fewer femoropopliteal bypasses (an operation that removes diseased blood vessels either above or below the knee) performed in 2015 than in 2010, with only Finland, Spain, Ireland, Cyprus (note there is a break in series) and Lithuania reporting increases in the frequency of this procedure. For bypass anastomosis for heart revascularisation (a bypass operation that concerns one or more coronary arteries), 13 of the 23 Member States for which data are available reported a decline in the frequency, while frequencies increased by more than 20 % in Lithuania, Hungary, Slovakia (in-patients only) and Cyprus (note that there was a break in series for the latter).

The removal of tonsils, a tonsillectomy, is also a relatively common procedure. Among 20 EU Member States, the frequency of tonsillectomies fell in 12; increases over 20 % were reported in Sweden and Cyprus (note that there was a break in series for the latter). The sharpest decline in tonsillectomies was in Denmark where the frequency dropped by over 40 %.

A total of 24 EU Member States have data available for the frequency of hysterectomies in 2010 and 2015 (2014 for Belgium). Eleven EU Member States reported increases in the frequency of this procedure, two of them over 20 %, while in the remaining 13 Member States the frequency of hysterectomies decreased, most notably in Denmark.

Open prostatectomy is a traditional surgical procedure to remove a man’s prostate gland. Among 22 EU Member States for which data are available, 14 reported decreases in the frequency of this procedure, seven of them in excess of 20 %, with the highest falls registered in Finland and the United Kingdom. The remaining eight Member States recorded increases, five of them by more than 20 %.

In-patient procedures: cataract surgery

Widespread fall in the use of in-patient procedures for cataract surgery

As already noted, one of the most common procedures conducted in the EU is cataract surgery. Several decades ago, this procedure required admission as an in-patient. From Figure 4 it can be seen that this is no longer the case in many of the EU Member States. In 2015, less than 10.0 % of procedures for cataract surgery were carried out as in-patient procedures in 13 of the EU Member States, with this share falling below 3.0 % in seven of these; the lowest share was 0.9 % in Estonia. In a further eight Member States less than half of the procedures for cataract surgery were performed on in-patients and as such at the other end of the scale there were only four Member States where more than half of the procedures for cataract surgery continued to be performed on in-patients: Lithuania, Poland, Romania and Bulgaria.

Between 2010 and 2015, the share of procedures for cataract surgery carried out on in-patients fell in nearly every EU Member State for which data are available, the exceptions being Bulgaria and Finland where it remained unchanged and Estonia where there was an increase.

Data sources and availability

Key concepts

Surgical procedures are all types of medical interventions involving an incision with instruments mostly performed in an operating theatre which normally involves anaesthesia and/or respiratory assistance. Surgical procedures can be performed either as in-patient cases, day cases or out-patient cases. Note that the statistics cover surgical procedures performed on in-patients and day care patients, except for cataract surgery and tonsillectomy for which the coverage is widened to include out-patients as well.

Only the main procedure performed on a patient during a hospital stay, day case or out-patient treatment should normally be reported.

An in-patient is a patient who is formally admitted (or ‘hospitalised’) to an institution for treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care. An in-patient or day care patient is discharged from hospital when formally released after a procedure or course of treatment (episode of care). A discharge may occur because of the finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death.

Healthcare resources and activities

Statistics on healthcare resources and healthcare activities (such as information on surgical operations and procedures) are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

For surgical operations and procedures the International Classification of Diseases — clinical modification (ICD-9-CM) is used.

For country specific notes on this data collection, please refer to this background information document. In particular, note that in general: data for Latvia, Slovakia and Iceland only concern in-patients; data for Cyprus, Ireland, Portugal, some parts of the United Kingdom, Liechtenstein and the former Yugoslav Republic of Macedonia only concern public hospitals, while the coverage of private hospitals is incomplete for Spain.

Note on tables: the symbol ':' is used to show where data are not available.

Context

For any particular type of surgical operation or procedure, the extent to which this is performed is influenced by a number of factors, including the size of the population and the incidence of the underlying disease or injury among the population. Other factors include differences in medical practices between countries and the availability of financial and human resources.

The European core health indicators (ECHI) shortlist includes an indicator on ‘Selected surgeries’ for eleven categories of surgical operations and procedures performed in hospitals in the chapter on health services.

See also

Online publications

Health status — selected diseases and related health problems

Healthcare activities

Methodology

General health statistics articles

Further Eurostat information

Database

Health care activities (hlth_act)
Operations, procedures and treatment (hlth_oper)
Surgical operations and procedures performed in hospitals by ICD-9-CM (hlth_co_proc2)

Dedicated section

Methodology / Metadata

Source data for tables and figures (MS Excel)

External links