Surgical operations and procedures statistics

Data extracted in October 2016. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: October 2017.

This article presents an overview of European Union (EU) statistics related to surgical operations and procedures. The article provides information for 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, 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Table 2: Surgical operations and procedures performed in hospitals — top 10 procedures, group 2, 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 1: Cataract surgery, 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 2: Colonoscopy with or without biopsy, 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 3: Caesarian sections, 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Table 3: Selected high growth procedures performed in hospitals, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Table 4: Selected large decline procedures performed in hospitals, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)
Figure 4: Share of in-patient procedures for cataract surgery, 2009 and 2014
(%)
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 2014; 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 4.3 million times across the EU Member States (Belgium 2013 data, Greece 2011 data, the Netherlands 2010 data; Latvia in-patients only), making this the most common of the surgical operations and procedures presented in this article. In Malta, the Czech Republic, Germany, Sweden, Estonia, France, Austria and Portugal, cataract surgery was performed 1.0 thousand times or more per 100 000 inhabitants in 2014, and Belgium (2013) and Greece (2011) also presented values over 1.0 thousand. By contrast, cataract surgery was performed fewer than 300 times per 100 000 inhabitants in Cyprus, Slovakia, Ireland and Latvia (in-patients only); this was also the case in Switzerland (in-patients only).


Another most common procedures were diagnostic bronchoscopies with or without biopsy (ICD-9-CM codes 33.21–33.24 and 33.27) and transluminal coronary angioplasties (ICD-9-CM codes 36.01, 36.02 and 36.05). The frequency of diagnostic bronchoscopies reached 685 per 100 000 inhabitants in Croatia and was above 400 in Latvia (in-patients only) and Germany. Among the remaining EU Member States for which data are available the frequency was in the range of 81–286 per 100 000 inhabitants, with Malta, Finland and Cyprus below this range. Transluminal coronary angioplasties were most common in Germany where they were performed on average 386 times per 100 000 inhabitants. They were conducted between 154 and 277 times per 100 000 inhabitants in most of the remaining Member States for which data are available, with Cyprus, the United Kingdom, Spain, Ireland, Portugal and Romania below this range.


The second most common of all of the types of surgical operations and procedures was 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 the United Kingdom, Ireland, Malta, Belgium (2013 data), France and Denmark, all over 1 400 per 100 000 inhabitants. In the remaining EU Member States for which data are available, the frequency of colonoscopies ranged from 246 to 1 095 per 100 000 inhabitants, with Slovenia, Cyprus, Finland and Hungary below this range.

In general, the frequency of appendectomies (ICD-9-CM codes 47.0 and 47.1) and cholecystectomies (ICD-9-CM codes 51.22 and 51.23) varied less between the EU Member States than did other procedures presented in Tables 1 and 2. Nevertheless, the frequency of laparoscopic appendectomies was notably higher in Germany, Belgium (2013 data), Ireland and Denmark than in the other EU Member States, while it was lower in Cyprus. The share of appendectomies that were performed laparoscopically varied greatly, from less than 10 % in Romania, and less than half in most Member States, to more than two thirds in Ireland, France, Germany, Belgium (2013 data) and Denmark. By contrast, the vast majority of cholecystectomies were performed laparoscopically, the share ranging from 77 % in Croatia and Romania to more than 90 % in the United Kingdom, the Netherlands (2010 data), Malta, Belgium (2013 data) Lithuania and Denmark.

Another most common procedures were 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 were typically undertaken between 150 and 240 times per 100 000 inhabitants, with Austria, Malta and Greece (2011 data) reporting higher frequencies and the United Kingdom, Romania, Cyprus and Ireland lower frequencies. In Germany, a majority (56 %) of these repairs were undertaken laparoscopically, with this share dropping below 45 % in all of the remaining EU Member States for which data are available, below 10 % in nine of the EU Member States and below 3 % in Italy, Portugal and Belgium (2013 data). Hysterectomies were most frequent in the Czech Republic (157 per 100 000 inhabitants), while they were least common in Denmark (17 per 100 000 inhabitants). More than half of all hysterectomies in Poland, Finland, the Czech Republic and Slovakia (in-patients only) were performed laparoscopically, a share that fell to around two fifths in Belgium (2013 data), to just below one third in Austria, France, Germany and Lithuania, to around one quarter in Italy, and less than one quarter elsewhere.


At least 1.38 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 2014, this procedure was performed 1.38 million times in the EU (2013 data for Belgium, Slovenia and Slovakia; 2010 data for the Netherlands; no data for Greece; note that data for Portugal and Slovakia only cover in-patients). More than 220 thousand caesarean sections were performed in Germany, while close to 196 thousand were performed in the United Kingdom and over 179 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 201 and 366 caesarean sections were performed per 100 000 inhabitants, with this procedure more frequent in Ireland and Romania, and less frequent in Croatia, the Netherlands (2010 data), Cyprus and Finland.

Hip replacements (ICD-9-CM codes 81.51–81.53) were the next most common procedures, performed 293 times per 100 000 inhabitants in Germany and 279 times per 100 000 inhabitants in Austria. Compared with their frequency in other EU Member States, secondary hip replacements (ICD-9-CM (2006) codes 00.70–00.77 and 81.53) were particularly common in Belgium (2013 data). Total knee replacements (ICD-9-CM code 81.54) were more common than hip replacements in Malta and Spain.

The detailed tables Microsoft Excel 2010 Logo.png are available here.

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 2009–14) is presented in Table 3; four of these concern laparoscopic techniques. The most rapid increases were observed for laparoscopic appendectomies 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 2009 and 2014, all reported an increase in this procedure, the only one exception being Belgium (for the period 2009–13). Eight Member States reported the frequency of this procedure more than doubling, the highest increases reported Hungary, Slovenia and Finland.

Laparoscopic hysterectomy (ICD-9-CM (2006) codes 68.31, 68.41, 68.51, 68.61 and 68.71) is a keyhole surgery to remove a woman’s uterus. All 18 EU Member States for which data are available for 2009 and 2014 reported an increase in this procedure, with only the Czech Republic, Slovenia and Slovakia reporting that the frequency had not increased by at least 30 %. Four Member States reported the frequency of this procedure more than tripling, with particular high increases in Romania and Hungary.

Laparoscopic repair of inguinal hernia involves covering the hernia defect with mesh from within the abdomen in order to fix it as a patch. Between 2009 and 2014, the frequency of laparoscopic repair of inguinal hernia increased in 15 of the 17 EU Member States for which data are available. Seven Member States reported the frequency of this procedure more than doubling, among them four more than tripling; the highest increases reported Portugal and Romania.

A cochlear implantation involves surgically implanting an electronic device to improve hearing. Although the absolute number of cochlear implantations remained relatively low, there was a widespread increase in this procedure. Among the 14 EU Member States for which data are available, only the United Kingdom and Spain reported increases in the frequency of this procedure by less than 10 %, while the frequency of cochlear implants more than doubled in Ireland and more than tripled in Hungary.

The frequency of laparoscopic colectomy (part of ICD-9-CM codes 45.7–8), in other words, keyhole surgery to remove part of the large intestine, increased between 2009 and 2014 in all 10 EU Member States for which data are available. The frequency of this operation almost doubled in Denmark, more than doubled in Spain (there was a change of definition between 2009 and 2014), and nearly quadrupled 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 that do not have a break in series, there were 11 Member States where there were fewer femoropopliteal bypasses performed in 2014 than in 2009, with only Ireland, Finland and Lithuania (2010–14) reporting increases in the frequency of this procedure. For a bypass anastomosis for heart revascularisation, 15 of the 23 Member States for which data are available reported a decline in the frequency, while frequencies increased by more than 20 % in Romania, Lithuania (2010–14), Slovakia (in-patients only), Hungary, Poland and Cyprus (note that there was a break in series).

The removal of tonsils, a tonsillectomy, is a relatively common procedure. Among 20 EU Member States, the frequency of tonsillectomies fell in 11; increases over 20 % were reported in Poland, Sweden and Cyprus (note that there was a break in series). The sharpest declines in tonsillectomies were in Denmark and Bulgaria where the frequency dropped by over 35 %.

A total of 24 EU Member States have data available for the frequency of hysterectomies in 2009 and 2014 (earlier or later data for some Member States). Hysterectomy is a traditional surgery to remove a woman’s uterus and it is also a relatively common procedure. Eight EU Member States reported increases in the frequency of this procedure, four of them over 20 %, while in the remaining 16 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 21 EU Member States for which data are available, 15 reported decreases in the frequency of this procedure, six of them in excess of 20 %, with the highest drops registered in Slovakia (in-patients only) and Finland. The remaining six Member States recorded increases, three of them 15 % or more.

In-patient procedures: cataract surgery

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

As already noted, the most common procedure 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 2014, less than 10.0 % of procedures for cataract surgery were carried out as in-patient procedures in 12 of the EU Member States, with this share falling below 3.0 % in seven of these; the lowest share was 0.8 % in Estonia. In further eight Member States less than half of the procedures for cataract surgery were performed on in-patients. On the other end of the scale there were three Member States where more than 80.0 % of the procedures for cataract surgery continued to be performed on in-patients — Bulgaria, Romania and Croatia.

Between 2009 and 2014, 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 Estonia where it remained unchanged.

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.

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, Portugal, Slovakia, Iceland and Switzerland 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