Statistics Explained

Surgical operations and procedures statistics

Data extracted in July 2022.

Planned article update: September 2023.

Highlights

At least 1.12 million caesarean sections performed in the EU in 2020.

Large positive rates of change reported in recent years by most EU Member States for keyhole surgery used to perform hysterectomies, appendectomies and repairs of inguinal hernias.

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

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Cataract surgery, 2020

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 as well as those that are being performed either more or less frequently than 10 years ago. These operations and procedures are classified according to the International Classification of Diseases – clinical modification (ICD-9-CM).

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.

It should be noted that data are presented in this article for 2020: for the first time, this article includes data that show an impact from the COVID-19 pandemic and its related restrictions. For this reason, particular attention should be paid when comparing the 2020 data with data from earlier years.

In some EU Member States, healthcare activities were impacted (particularly at the start of the pandemic) by an influx of patients with COVID-19. The pandemic also resulted in a range of knock-on effects including, among others, some services being curtailed/postponed due to the number of COVID-19 patients, staff shortages within hospitals and day care centres due to infection/quarantine procedures, and patients being hindered in accessing medical services due to their own infection/quarantine as well as lockdown or travel restrictions.

Full article

Number of surgical operations and procedures

The two most common surgical operations and procedures performed in EU hospitals (for which data are collected) were cataract surgery and caesarean sections

Tables 1 and 2 indicate how frequently a selection of the most common surgical operations and procedures were conducted in 2020; in both tables the data are presented relative to the size of the population (per 100 000 inhabitants). For several of these operations and procedures, such as cholecystectomies, 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, 2020
(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 3.66 million times in 2020 across the EU Member States (Belgium, Cyprus, Malta and the Netherlands, 2019 data; Greece, no recent data available), making this the most common of the surgical operations and procedures presented in this article. In 10 of the Member States, cataract surgery was performed 1 000 times or more per 100 000 inhabitants in 2020 (or another recent year – see Figure 1 for details of coverage), peaking at 1 461 times per 100 000 inhabitants in Latvia. By contrast, cataract surgery was performed fewer than 300 times per 100 000 inhabitants in Romania.

Figure 1: Cataract surgery, 2020
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

At least 1.12 million caesarean sections performed in the EU

Another common procedure was a 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 2020, this procedure was performed at least 1.12 million times in the EU (Cyprus, Malta and the Netherlands, 2019 data; Portugal, in-patients only; Greece, no recent data available). A total of 234 000 caesarean sections were performed in Germany, while between 131 400 and 147 600 were performed in France, Poland and Italy; note also the high number of caesarean sections performed in Turkey (637 100) in 2020.

In most of the EU Member States, between 200 and 400 caesarean sections were performed per 100 000 inhabitants in 2020 (see Figure 2), with this procedure more frequent in Romania and Cyprus (2019 data), and less frequent in Estonia, Slovenia, Sweden, Spain, Lithuania, Finland and the Netherlands (2019 data).

Figure 2: Caesarean section, 2020
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


Transluminal coronary angioplasties concern the opening up of blocked coronary arteries (ICD-9-CM codes 36.01, 36.02 and 36.05). In 2020, transluminal coronary angioplasties were most common (relative to population size) in Croatia and Germany where they were performed on average 462 and 384 times per 100 000 inhabitants respectively. They were conducted between 150 and 329 times per 100 000 inhabitants in most of the remaining Member States for which data are available, with Portugal, Spain, Luxembourg and Romania below this range.

Hip replacements (ICD-9-CM codes 81.51–81.53) were performed 294 times per 100 000 inhabitants in Germany in 2020 and between 250 and 269 times per 100 000 inhabitants in Finland, Austria, the Netherlands (2019 data) and Denmark; these were the highest frequencies among the EU Member States for which data are available (see Table 1). Fewer than 100 hip replacements were performed per 100 000 inhabitants in Portugal, Malta (2019 data), Cyprus (2019 data) and Romania.

In general, the frequency of cholecystectomies (removal of the gall bladder; 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. Concerning laparoscopic cholecystectomies, the frequency in 2020 was highest in Germany, Lithuania and Belgium, all above 180 per 100 000 inhabitants. It was lowest in Ireland, Cyprus (2019 data), Malta (2019 data) and Bulgaria, all below 100 per 100 000 inhabitants. The share of cholecystectomies that were performed laparoscopically varied little: with the exception of Bulgaria (30 %), the vast majority of cholecystectomies were performed laparoscopically, their share in 2020 ranging from 81 % in Romania to 95 % in Malta and the Netherlands (both 2019 data).

Table 2: Surgical operations and procedures performed in hospitals – top 10 procedures group 2, 2020
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)


Repairs of inguinal hernias involve covering the hernia defect with mesh from within the abdomen in order to patch it (ICD-9-CM codes 53.0 and 53.1). Repairs of inguinal hernia were typically undertaken between 120 and 200 times per 100 000 inhabitants in 2020, with Malta (2019 data) and Austria reporting a higher frequency while Poland, Cyprus (2019 data), Ireland and Romania reported lower frequencies. In Germany, Denmark, Belgium, Austria, the Netherlands (2019 data) and Czechia, a majority (up to 66 %) of these repairs were undertaken laparoscopically. This share was below 50 % in the remaining EU Member States for which data are available; the share was below 10 % in five of the EU Member States and was lowest (at 4.9 %) in Italy.

The frequency of knee replacements (ICD-9-CM code 81.54) varied more between the EU Member States than did hip replacements. Furthermore, with the exception of Malta, total knee replacements were less common than hip replacements. More than 200 knee replacements per 100 000 inhabitants were performed in 2020 in Finland and Germany, compared with less than 50 per 100 000 inhabitants in Portugal, Cyprus (2019 data), Bulgaria and Romania.

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 most other procedures presented in Tables 1 and 2 and much less than the frequency of laparoscopic appendectomies. The frequency of the latter in 2020 was higher in Belgium, Finland, Denmark and Germany than in the other EU Member States, while it was lowest in Romania and Bulgaria. The share of appendectomies that were performed laparoscopically varied greatly, from 14 % of the total number of these procedures in Bulgaria to over 80 % in eight Member States, including Belgium and Denmark where the share exceeded 90 %.

The frequency of partial excisions of mammary glands (ICD-9-CM codes 85.2–85.23) varied quite considerably between the EU Member States in 2020. In Belgium and Finland, this procedure was performed more than 100 times per 100 000 inhabitants while in Cyprus (2019 data) it was performed less than 10 times per 100 000 inhabitants.

Another common procedure performed within the EU was hysterectomies (the removal of all or part of the uterus; ICD-9-CM codes 68.3–68.7 and 68.9). Hysterectomies were most frequently performed in 2020 in Czechia (119 per 100 000 inhabitants). In most of the other EU Member States the frequency ranged from 40 to 110 per 100 000 inhabitants. A notable exception was Denmark where the frequency was 3.5 per 100 000 inhabitants. More than half of all hysterectomies in Finland, Poland, Czechia, Estonia, Belgium and the Netherlands (2019 data) were performed laparoscopically. Shares were below 20 % in six Member States, with the lowest share – the only one below 10 % – in Romania (where 6 % of hysterectomies were performed laparoscopically).

Increasing and decreasing surgical operations and procedures

Large increases reported for hysterectomies performed using keyhole surgery

A selection of surgical operations and procedures which have generally become more frequent during recent years is presented in Table 3; three of these concern laparoscopic techniques. Data are generally presented for 2010 and 2020: alternative years are presented for some EU Member States – see Table 3 for the precise coverage.

Table 3: Selected high growth procedures performed in hospitals, 2010 and 2020
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

The most rapid increase (relative to population size) was observed for laparoscopic hysterectomies (keyhole surgery to remove all or part of the uterus). Between 2010 and 2020, the frequency of laparoscopic hysterectomies increased in 21 of the 22 EU Member States for which data are available, the exception being Slovenia. Eight Member States reported the frequency of this procedure more than doubling during the period under consideration. The largest relative increase was in Hungary where it was approximately 12 times as common in 2020 as it had been in 2010 (up from 1.3 to 15.7 procedures per 100 000 inhabitants).

Among the 22 EU Member States for which data are available for 2010 and 2020, all but one reported an increase in laparoscopic appendectomies; the exception was Germany where the frequency relative to the population size fell marginally. The frequency of this procedure more than doubled in 12 Member States. The biggest increases were in Cyprus (2013–2019) and Malta (2012–2019), where the frequencies were 6.0 and 8.3 times as high in 2019 as in the earlier year.

Between 2010 and 2020, the frequency of laparoscopic repair of inguinal hernia increased in 19 of the 22 Member States for which data are available. In Croatia, there was no change (2012–2020), while in Finland there was a relatively small decrease and in Sweden a larger one. In 11 Member States, the frequency of this procedure more than doubled during the period under consideration. By far the largest relative increases were observed in Portugal and Slovenia, the frequency being 12.5 times as high in 2020 as in 2010 in the former and 14.7 times as high in the latter; note however that in both cases the frequency of laparoscopic repair of inguinal hernia in 2010 was relatively low (less than 2 procedures per 100 000 inhabitants).

Transluminal coronary angioplasty was the most common procedure among those shown in Table 3. In 16 out of the 23 EU Member States for which data are available, the frequency of transluminal coronary angioplasties increased between 2010 and 2020. The largest increase was in Cyprus between 2010 and 2019, but there is a break in series. Elsewhere, the largest increase was in Croatia, where the frequency in 2020 was 2.5 times as high as in 2012. The decrease in frequency observed in seven Member States was most substantial in Luxembourg, down more than two fifths.

Stem cell transplantation was the least common procedure among those shown in Table 3. A total of 19 out of 22 EU Member States for which data are available for 2010 and 2020 reported an increase in the number of transplants. The exceptions were Malta (2012–2019) where the number remained at zero, and Lithuania and Portugal where the frequency declined. Aside from Cyprus (where there is a break in series), the largest increase was in Romania, where the frequency was nearly seven times as high in 2020 as in 2010.

Tonsillectomies were performed with a decreasing frequency

A selection of surgical operations and procedures which have become less common in recent years is presented in Table 4. Three of these – hysterectomies, appendectomies, and repair of inguinal hernias – are procedures whose overall frequencies have declined despite relatively fast growth in their performance using laparoscopic techniques. In other words, the increase in the frequency of these procedures using laparoscopic techniques was less than the overall decrease in these procedures. Data are generally presented for 2010 and 2020: alternative years are presented for some EU Member States – see Table 4 for the precise coverage.

Table 4: Selected large decline procedures performed in hospitals, 2010 and 2020
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

The removal of tonsils, a tonsillectomy, remains a relatively common procedure despite a decline in its frequency; note that the data for this procedure also includes surgery performed on out-patients. Among 24 EU Member States for which data are available, the frequency of tonsillectomies fell in 22 between 2010 and 2020. Moderate increases were reported in Cyprus (where there is a break in series) and Sweden. The sharpest decline in the frequency of tonsillectomies was recorded in Bulgaria, down by more than four fifths.

A total of 25 EU Member States have data available for the frequency of hysterectomies. Cyprus was the only Member State to report an increase in the frequency of this procedure, although there is a break in series. The frequency fell by a quarter or more in 17 Member States. Only in Denmark did the frequency fall by more than half, decreasing from 28.3 to 3.5 per 100 000 between 2010 and 2020.

For bypass anastomosis for heart revascularisation (a bypass operation that concerns one or more coronary arteries), 21 of the 24 Member States for which data are available reported a decline in the frequency between 2010 and 2020. While the frequency of carrying out bypass anastomosis for heart revascularisation increased greatly in Cyprus, there is a break in series. More modest increases were observed in Ireland (where there is also a break in series) and in Slovakia. Decreases of two fifths or more in the frequency were reported for Sweden and Malta (2010–2019), while in Luxembourg the frequency in 2020 was around two thirds lower than it had been in 2010.

Based on data for the 26 EU Member States for which data are available, around four fifths (21) recorded fewer appendectomies performed in 2020 than in 2010. The frequency of this operation more than halved in Bulgaria and was down by around two thirds in Romania. The largest increase in the frequency of this procedure was 26 % in Finland, with smaller increases in Malta (2012–2019), Denmark, Croatia (2012–2019) and Sweden.

Among 24 EU Member States for which data are available, 22 reported decreases in the frequency of repairs of inguinal hernias; the only exceptions were Cyprus (2010–2019) and Ireland, both of which have a break in series. There were five Member States where the frequency of carrying out a repair of an inguinal hernia fell by at least one quarter, among which Italy was the only one to record a decrease of more than a half.

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. Figure 3 shows that this is no longer the case in many of the EU Member States (no data available for Greece). In 2020, less than 10.0 % of procedures for cataract surgery were carried out as in-patient procedures in 20 of the Member States. The lowest shares – less than 1.0 % – were recorded in Denmark, Spain, Slovenia and the Netherlands (2019 data). There were two Member States where more than half of the procedures for cataract surgery in 2020 were performed on in-patients, Bulgaria (56.6 %) and Romania (60.2 %).

Figure 3: Share of in-patient procedures for cataract surgery, 2010 and 2020
(%)
Source: Eurostat (hlth_co_proc2)

Between 2010 and 2020, 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 were Finland and Estonia where the low shares increased but remained lower than in most (other) Member States. In 16 Member States, the share of these procedures carried out on in-patients fell by more than half. The largest relative decrease was in Luxembourg, down from 51.4 % carried out on in-patients in 2010 to 1.8 % in 2020.

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 whether 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, please refer to this background information document which is an annex to the metadata on health care activities: background information document. In particular, note that:

  • data for Ireland and North Macedonia only concern public hospitals;
  • data for Cyprus and Portugal generally only concern public hospitals, however coverage is complete for caesarean sections;
  • data for Slovenia have an incomplete coverage of private hospitals.

Symbols

Tables in this article use the following notation:

Value in italics    estimate or provisional data;
Value is :  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 11 categories of surgical operations and procedures performed in hospitals in the chapter on health interventions: health services indicators.

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