Surgical operations and procedures statistics

Data extracted in September 2020.

Planned article update: November 2021.

Highlights

At least 1.16 million caesarean sections performed in the EU-27 in 2018.

Large positive rates of change reported in recent years by most EU Member States for keyhole surgery used to perform hysterectomies 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.

Cataract 2018.JPG

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 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 2018; 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, 2018
(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 4.3 million times in 2018 across the EU Member States, making this the most common of the surgical operations and procedures presented in this article (Malta and the Netherlands, 2017 data; Portugal, 2015 data; Greece, no recent data available). In 13 of the Member States, cataract surgery was performed 1 000 times or more per 100 000 inhabitants in 2018 (or another recent year — see Figure 1 for details of coverage), peaking at 1 656 times per 100 000 inhabitants in Latvia. By contrast, cataract surgery was performed fewer than 400 times per 100 000 inhabitants in Cyprus and Ireland.

Figure 1: Cataract surgery, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

At least 1.4 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 2018, this procedure was performed at least 1.16 million times in the EU (Malta and the Netherlands, 2017 data; Portugal, 2015 data only cover in-patients; Greece, no recent data available). A total of 233 300 caesarean sections were performed in Germany, while 146 200 to 151 100 were performed in Poland, France and Italy; note also the high number of caesarean sections performed in Turkey (685 500) in 2018. In most of the EU Member States, between 200 and 4000 caesarean sections were performed per 100 000 inhabitants in 2018 (see Figure 2), with this procedure more frequent in Cyprus, Romania and Ireland, and less frequent in Spain, Sweden, Lithuania, the Netherlands (2017 data) and Finland.

Figure 2: Caesarean section, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

Transluminal coronary angioplasties concern opening up of blocked coronary arteries (ICD-9-CM codes 36.01, 36.02 and 36.05). In 2018, transluminal coronary angioplasties were most common in Croatia and Germany where they were performed on average 411 and 409 times per 100 000 inhabitants respectively. They were conducted between 155 and 312 times per 100 000 inhabitants in most of the remaining Member States for which data are available, with Ireland, Luxembourg, Romania, Portugal (2015 data; in-patients only) and Spain below this range.

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. Nevertheless, the frequency of laparoscopic cholecystectomies in 2018 was notably higher in Lithuania than in the other EU Member States, while it was lowest in Bulgaria, Cyprus, Ireland and Malta (2017 data). The share of cholecystectomies that were performed laparoscopically varied little: with the exception of Bulgaria (46 %), the vast majority of cholecystectomies were performed laparoscopically, their share in 2018 ranging from 77 % in Latvia (in-patients only) to 94 % in Denmark, Lithuania and the Netherlands (2017 data).

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 140 and 240 times per 100 000 inhabitants in 2018, with Austria reporting a higher frequency and Romania, Cyprus and Ireland lower frequencies. In Germany, Denmark, Belgium and Austria, a majority (51-64 %) 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 six of the EU Member States and below 5 % in Italy and Portugal (2015 data).

Table 2: Surgical operations and procedures performed in hospitals — top 10 procedures group 2, 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

Hip replacements (ICD-9-CM codes 81.51-81.53) were performed 311 times per 100 000 inhabitants in Germany in 2018 and between 275 and 300 times per 100 000 inhabitants in Austria, Belgium and Finland; these were the highest frequencies among the EU Member States for which data are available (see Table 2).

The frequency of knee replacements (ICD-9-CM code 81.54) varied more between the EU member States that did hip replacements. Furthermore, with the exceptions of Spain, Malta (2017 data) and Luxembourg, total knee replacements were generally somewhat less common than hip replacements. More than 200 knee replacements per 100 000 inhabitants were performed in 2018 in Finland, Austria, Germany and Belgium, compared with less than 50 per 100 000 inhabitants in Ireland, Bulgaria and Romania.

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 2018 was notably higher in Belgium, Germany, Ireland, Denmark and Finland than in the other EU Member States, while it was lowest in Poland, Romania, Cyprus and Bulgaria. The share of appendectomies that were performed laparoscopically varied greatly, from 9 % of the total number of these procedures in Bulgaria to more than four fifths in the Netherlands (2017 data), Ireland, Germany, France and Belgium, peaking in Denmark at 92 %.

The frequency of tonsillectomies, the removal of tonsils, include total and partial tonsillectomies with or without adenoidectomies (ICD-9-CM codes 28.2-28.4) varied more between the EU Member States than did most of the other procedures presented in Tables 1 and 2. Note that the data for tonsillectomies include not only the number of procedures carried out on in-patients and day care patients, but also the number carried out on out-patients. This procedure was carried out 355 times per 100 000 inhabitants in 2018 in Estonia and just over 200 times per 100 000 inhabitants in Finland and Belgium. By contrast, tonsillectomies were performed less than 100 times per 100 000 inhabitants in 14 of the EU member States, among which Italy had the lowest frequency (49 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 2018 in Czechia (148 per 100 000 inhabitants) and Lithuania (141 per 100 000 inhabitants), while they were least common in Denmark (6 per 100 000 inhabitants). More than half of all hysterectomies in Finland, Estonia, Czechia, Poland and Belgium were performed laparoscopically. Elsewhere shares were below 25 % in eight EU Member States, with the lowest shares — the only ones below 10 % — in Cyprus and Romania (where 4 % 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 become more frequent during recent years is presented in Table 3; three of these concern laparoscopic techniques. Data are generally presented for 2013 and 2018: 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, 2013 and 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

The most rapid increase was observed for laparoscopic hysterectomies (keyhole surgery to remove all or part of the uterus). Between 2013 and 2018 (see Table 3 for precise information on alternative years for some EU Member States), the frequency of laparoscopic hysterectomies increased in 20 of the 21 Member States for which data are available, the exception being Cyprus. Two Member States — Sweden and Croatia — reported the frequency of this procedure more than doubling during the period under consideration, while in Hungary it was more than four times as frequent in 2018 than it had been in 2013.

Between 2013 and 2018 (see Table 3 for precise information on alternative years for some EU Member States), the frequency of laparoscopic repair of inguinal hernia also increased in 20 of the 21 Member States for which data are available, the exception being Finland. Four Member States — Hungary, Spain (note that there is a break in series), Romania and Lithuania — reported the frequency of this procedure more than doubling during the period under consideration, while in Cyprus it more than tripled between 2013 and 2018, and in Slovenia it was 5.7 times as common in 2018 as in 2013.

A total of 22 out of 24 EU Member States for which data are available for 2013 and 2018 reported an increase in the number of knee replacements; the exceptions were Ireland and Sweden. Two Member States — Latvia (in-patients only) and Poland — reported the frequency of this procedure more than doubling.

Transluminal coronary angioplasty was the most common operation among the procedures shown in Table 3. In 19 out of 22 EU Member States for which data are available, the frequency of transluminal coronary angioplasties increased between 2013 and 2018; Spain (note that there is a break in series), Estonia and Luxembourg were the only exceptions. The largest increase was in Cyprus, where the number of these procedures (relative to population size) more than doubled; the next largest increase was 80 % in Croatia.

Among the 22 EU Member States for which data are available for 2013 and 2018, all but one reported an increase in laparoscopic appendectomies; the exception was Germany where the frequency relative to the population size fell slightly. Two Member States —Lithuania and Estonia — reported the frequency of this procedure more than doubling, while there were even faster expansions in Slovenia (3.5 times as high in 2018 as in 2013), Malta (3.5 times as high in 2017 as in 2013) and Cyprus (5.6 times as high in 2018 as in 2013.

Tonsillectomies and bypass anastomosis for heart revascularisation, 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. Three of these — appendectomies, hysterectomies 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 decrease in these procedures using more invasive, traditional techniques. Data are generally presented for 2013 and 2018: 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, 2013 and 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_proc2)

The removal of tonsils, a tonsillectomy, remains a relatively common procedure despite a decline it its frequency. Among 23 EU Member States for which data are available, the frequency of tonsillectomies fell in 21 between 2013 and 2018. Increases were reported in Lithuania (up 16 %) and Croatia (up 25 %). The sharpest declines in tonsillectomies were recorded in Luxembourg and Germany, where the frequency dropped by 35 % and 37 % respectively.

For bypass anastomosis for heart revascularisation (a bypass operation that concerns one or more coronary arteries), 19 of the 23 Member States for which data are available reported a decline in the frequency between 2013 and 2018, including all of the four largest Member States. While the frequency of carrying out bypass anastomosis for heart revascularisation increased by 53 % in Croatia and by 38 % in Slovakia between 2013 and 2018, it was far more commonplace for declines to be recorded. The largest declines were in Malta (down 42 % between 2013 and 2017) and Luxembourg (down 63 % between 2013 and 2018).

Based on data for the25 EU Member States for which data are available, around two thirds (17) recorded fewer appendectomies performed in 2018 than in 2013, including the four largest EU Member States. The largest increase in the frequency of this procedure was 15 % in Croatia, whereas Romania recorded the largest decrease, down 41 %.

A total of 24 EU Member States have data available for the frequency of hysterectomies in 2013 and 2018. Only two Member States reported an increase in the frequency of this procedure, with a 9 % gain in Croatia being far greater than the gain of less than 1 % in Lithuania. In the remaining 22 Member States, the frequency of hysterectomies decreased, most notably in Denmark (down 69 % between 2013 and 2018).

Among 23 EU Member States for which data are available, 13 reported decreases in the frequency of repairs of inguinal hernias, including two of the four largest Member States. There were seven Member States where the frequency of carrying out a repair of an inguinal hernia fell by an amount in excess of 10 %, with the highest fall registered in Finland (down 15 %). Nine of the remaining Member States recorded increases, two of them — Cyprus and Croatia — by more than 30 %. In Ireland, the frequency of repairs of inguinal hernias was the same in 2018 as it had been in 2013.

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. In 2018, less than 10.0 % of procedures for cataract surgery were carried out as in-patient procedures in 15 of the Member States; the lowest shares — less than 1.0 % — were recorded in Estonia, Denmark and the Netherlands (2017 data). In a further six Member States, less than half of the procedures for cataract surgery were performed on in-patients. 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: Poland, Lithuania, Bulgaria and Romania (which had the highest share, 66.0 %).

Figure 3: Share of in-patient procedures for cataract surgery, 2013 and 2018
(%)
Source: Eurostat (hlth_co_proc2)

Between 2013 and 2018, 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 Sweden where the share was low and unchanged (1.6 % in both years) and Estonia where there was a small increase (up 0.1 percentage points; note that the overall share of in-patient surgery remained below 1.0 %). Among the non-member countries shown in Figure 3, there was also no change in Norway, where the share of in-patient surgery also remained relatively low, at 3.8 %.

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 Ireland, Cyprus, the Netherlands, Portugal, some parts of the United Kingdom and North Macedonia only concern public hospitals, while the coverage of private hospitals is incomplete for Spain and Slovenia.

Symbols

Note on tables:

  • a colon ‘:’ is used to show where data are not available;
  • a dash ‘–‘ is used to show where data are not applicable/relevant.

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 (hlth_care)
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)