Surgical operations and procedures statistics

Data extracted in July 2018.

Planned article update: August 2019.

Highlights

At least 1.32 million caesarean sections performed in the EU in 2016.

Large increases reported in recent years by most EU Member States for appendectomies performed using keyhole surgery.

In nearly all EU Member States there has been a fall in recent years in the use of in-patient procedures for cataract surgery.

Figure: Cataract surgery, 2016

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.

Full article

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 or 2016; 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.

Table 1: Surgical operations and procedures performed in hospitals — top 10 procedures group 1, 2015 or 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


Cataract surgery (ICD-9-CM codes 13.1-13.8), the extraction of the lens from an eye, was conducted 4.5 million times in 2016 across the EU Member States (Spain, Malta and Portugal, 2015 data; the Netherlands, 2014 data; excluding Greece; Latvia in-patients only), making this one of the two most common of the surgical operations and procedures presented in this article. In 13 of the Member States, cataract surgery was performed 1.0 thousand times or more per 100 000 inhabitants in 2016 (or another recent year — see Figure 1), peaking at 1.4 thousand times per 100 000 inhabitants in Portugal (2015 data). 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.

Figure 1: Cataract surgery, 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


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 2015 in Sweden, Luxembourg, the United Kingdom, Ireland, Malta and Belgium (2014 data), all over 1 000 per 100 000 inhabitants, with even higher frequencies — between 2 000 and 3 000 per 100 000 inhabitants — in Croatia, France (2014 data) and Denmark. 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 Portugal (2014 data), Cyprus, Slovenia, Finland and Hungary below this range.

Figure 2: Colonoscopy with or without biopsy, 2015
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


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 80-307 per 100 000 inhabitants, with Malta, Finland and Cyprus below this range. In 2016, transluminal coronary angioplasties were most common in Germany and Croatia where they were performed on average 406 and 354 times per 100 000 inhabitants respectively. They were conducted between 195 and 285 times per 100 000 inhabitants in most of the remaining Member States for which data are available, with Finland, Cyprus, the United Kingdom, Spain (2015 data), Ireland, Portugal (2015 data) and Romania below this range.

In general, the frequency of appendectomies (removal of an (infected) appendix; 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 2016 was notably higher in Germany, Belgium, 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 12 % of the total number of these procedures in Romania, and less than three quarters in most Member States, to 77 % in Ireland and more than four fifths in France, Germany and Belgium, peaking in Denmark at 90 %. 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 in 2016 ranging from 73 % in Latvia (in-patients only) to 93 % in Denmark.

Table 2: Surgical operations and procedures performed in hospitals — top 10 procedures group 2, 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


Other common procedures performed within the EU included repairs of inguinal hernias (covering the hernia defect with mesh from within the abdomen in order to patch it; ICD-9-CM codes 53.0 and 53.1) and hysterectomies (the removal of all or part of the uterus; ICD-9-CM codes 68.3-68.7 and 68.9). Repairs of inguinal hernia were typically undertaken between 150 and 250 times per 100 000 inhabitants in 2016, with Austria and Malta (2015 data) reporting higher frequencies and the United Kingdom, Romania, Cyprus and Ireland lower frequencies. In Germany, a majority (60 %) of these repairs were undertaken laparoscopically, as were half (50 %) of these operations in Belgium. In all of the remaining EU Member States for which data are available this share was below 50 %; the share was below 10 % in eight of the EU Member States and below 5 % in Spain (2015 data), Italy and Portugal (2015 data). Hysterectomies were most frequently performed in 2016 in Czechia (157 per 100 000 inhabitants), while they were least common in Denmark (10 per 100 000 inhabitants). More than half of all hysterectomies in Finland, Poland, Czechia, Slovakia, Estonia and Belgium were performed laparoscopically, while the share was between one third and two fifths in the Netherlands (2014 data), Austria, France, Lithuania and Germany. Elsewhere lower shares were recorded, most notably in Croatia and Malta (2015 data) where 9 % of hysterectomies were performed laparoscopically and in Romania where the share was just 3 %.

At least 1.32 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 2016, this procedure was performed 1.32 million times in the EU (2015 data for Czechia; 2014 data for the Netherlands; no data for Greece; note that data for Portugal only cover in-patients). A total of 237 thousand caesarean sections were performed in Germany, while 204 thousand were performed in the United Kingdom, between 165 thousand and 147 thousand in Italy, France and Poland and 100 thousand in Spain. In most of the EU Member States, between 200 and 400 caesarean sections were performed per 100 000 inhabitants in 2016, with this procedure more frequent in Cyprus, Romania and Ireland, and less frequent in the Netherlands (2014 data) and Finland.

Figure 3: Caesarean section, 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


Hip replacements (ICD-9-CM codes 81.51-81.53) were performed 304 times per 100 000 inhabitants in Germany in 2016 and between 273 and 265 times per 100 000 inhabitants in Austria, Finland and Belgium; these were the highest frequencies among the EU Member States for which data are available.

Increasing and decreasing surgical operations and procedures

Large increases reported for appendectomies performed using keyhole surgery

A selection of surgical operations and procedures which have become more frequent during recent years 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 appendectomies (keyhole surgery to remove an (infected) appendix).

Table 3: Selected high growth procedures performed in hospitals, 2010, 2011, 2015 and 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


Laparoscopic appendectomy was the most common operation among the five procedures shown in Table 3. Among the 23 EU Member States for which data are available for 2011 and 2016, all reported an increase in this procedure. Three Member States — Estonia, Cyprus (both 2013-2016) and Finland — reported the frequency of this procedure more than doubling, while a further three — Lithuania, Slovenia and Malta (2012-2015) — reported a trebling of the frequency.

A total of 22 out of 23 EU Member States for which data are available for 2011 and 2016 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 fall in frequency. Four Member States reported the frequency of this procedure more than doubling, while in Romania it tripled and in Hungary it quadrupled.

Between 2011 and 2016, the frequency of laparoscopic repair of inguinal hernia increased in 21 of the 22 EU Member States for which data are available, the exception being Sweden. Two Member States (Lithuania and Romania) reported the frequency of this procedure more than doubling during this period, while in Portugal it more than tripled between 2011 and 2015, in Malta it was 4.7 times as common in 2015 as in 2012, and in Slovenia it was 10.3 times as common in 2016 as in 2011.

Although the absolute number of cochlear implantations remained relatively low, there was a widespread increase in this procedure. Among the 17 EU Member States for which data are available for 2010 and 2015, only Lithuania and Croatia (2012-2015) reported decreases 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. There was also a large increase in Cyprus, from no such operations in 2010 to 2.7 per 100 000 inhabitants in 2015.

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 10 of the 13 EU Member States for which data: in Romania this procedure was not conducted and the frequency fell strongly in Portugal (2010-2014) and Croatia (2012-2015). The frequency of this operation more than tripled in Sweden between 2010 and 2015.

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 19 EU Member States for which data are available, there were 10 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, including Italy, Germany, France and the United Kingdom. The largest of the Member States to report an increase in the frequency of this procedure was Spain. For bypass anastomosis for heart revascularisation (a bypass operation that concerns one or more coronary arteries), 18 of the 25 Member States for which data are available reported a decline in the frequency between 2011 and 2016, again including four of the five largest Member States. The frequency increased by more than 20 % in Romania, Slovakia (in-patients only), Croatia (2012-2016) and Cyprus (2012-2016; note that there was a break in series).

Table 4: Selected large decline procedures performed in hospitals, 2010, 2011, 2015 and 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


The removal of tonsils, a tonsillectomy, is also a relatively common procedure. Among 24 EU Member States, the frequency of tonsillectomies fell in 16. Small increases were reported by Spain and the United Kingdom (among the largest Member States) while increases over 20 % were reported in Croatia (2012-2016), Cyprus (2012-2016; note that there was a break in series), Sweden and Slovenia. The sharpest decline in tonsillectomies was in Germany where the frequency dropped by 34 %.

A total of 26 EU Member States have data available for the frequency of hysterectomies in 2011 and 2016 (other recent years for some Member States). Seven Member States reported increases in the frequency of this procedure, peaking at 38 % in Cyprus (2012-2016; note that there is a break in series). In the remaining 20 Member States — including all five of the largest 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 25 EU Member States for which data are available, 16 reported decreases in the frequency of this procedure, including four of the largest Member States; 6 of these 16 reported falls in excess of 20 %, with the highest fall registered in Finland. The remaining nine Member States recorded increases, six of them by more than 20 %; note that these nine Member States also include Malta, where the frequency increased from none in 2012 to 0.9 per 100 000 inhabitants in 2015.

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 2016, 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 nine of these; the lowest share was 0.8 % 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, Bulgaria, Poland and Romania.

Figure 4: Share of in-patient procedures for cataract surgery, 2011 and 2016
(%)
Source: Eurostat (hlth_co_proc2)


Between 2011 and 2016, 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 exception being Estonia where there was a small increase (up 0.3 percentage points); note that there was also an increase in Norway (2012-2016).

Source data for tables and graphs

Data sources

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.

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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)