Surgical staff and the resources they need to practice account for a substantial proportion of the NHS activity and front-line care for patients. With continuing innovation an increasing number of medical conditions are being remedied or managed by surgery. Site Search Site Search Go. Account login Username.
Show password. Included are cases of death, excluded are day-cases. Counted is the number of patients undergoing procedures according to OPS, no matter how many operations were accomplished. Each patient counted one time. This includes diagnostic procedures as well. In the coverage of hospitals was Source: Federal Statistical Office, Hospital statistics - diagnostic data of the hospital patients.
The data is the case number of department discharges. The Directorate of Health. Data from corrected. This was based on OECD shortlist for inpatient surgery but now the numbers represent all procedures performed as in-patient surgery. Coverage: HIPE data covers all in-patients and day cases receiving curative and rehabilitative care in publicly funded acute hospitals in the State.
HIPE data do not include private hospitals. The definition of day case is a patient who is formally admitted with the intention of discharging the patient on the same day, and where the patient is in fact discharged as scheduled i.
All other patients, including those who are admitted or discharged as emergencies on the same day, are considered in-patients. In accordance with WHO guidelines, day cases have been excluded from the data presented for discharges. This ensures consistency in HIPE data reported by international organisations. Deviation from the definition: The data on surgical procedures for all years are based on the number of inpatients with a surgical DRG Diagnosis Related Group.
As DRG designation is primarily based on the main diagnosis and main procedure and other factors such as age , the data only include the main procedure. For this reason, the surgical DRG methodology is used for all years. 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 , less than 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, Between and , 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.
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.
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 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. 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 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.
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. Tools What links here Special pages. Data extracted in September Planned article update: February At least 1. There was a consistent decrease in 30 day postoperative mortality restrictive category , from 1. Similarly, the 90 day mortality rate decreased from 3.
We present the 10 procedures with the highest crude 30 day mortality rate over five years for each category in the Supplementary data , Table S7. The procedure category with the highest mortality rate was pericardial procedures L18 , which carries a The mortality rate associated with laparotomy T30 was As a proportion of national deaths, mortality within 90 days of a hospital procedure accounted for Flow diagram showing Office of Population Censuses and Surveys version 4 OPCS4 codes included in each category of surgery inclusive, intermediate or restrictive.
Procedure frequency using the inclusive category shown on the right axis in multiples of 1 procedures. It is unclear whether the observed reduction in mortality rates between and reflect improvements in perioperative care or are an artefact of the increasing frequency of procedures. The combined number of in-hospital and out of hospital deaths following hospital procedures in England, Scotland and Wales per financial year with crude unadjusted mortality rates as a proportion of the total number of procedures, stratified according to three categories of surgery.
Mortality data were not available for Northern Ireland. Aggregate post-procedure mortality in England, Scotland and Wales between April 1, and March 31, Post-procedure mortality as a proportion of National deaths. This excluded procedures with length of stay stated as zero days i. Median length of stay in England and Wales restrictive reduced from 5.
We present the five procedures with the highest median length of stay for each category in the Supplementary data , Table S8. Open heart assistance procedures K54 had the longest length of stay [ We present the five procedures attracting the largest aggregate payments over five years, and the number of procedures performed in the Supplementary data , Table S9. This represents a 5. There were minor procedure codes, intermediate, major, major plus and complex major. Using this classification there were a total of 7 procedures and 85 1.
The average median length of stay was 2. When we applied the average 30 day post-procedure mortality rate for England, Scotland and Wales to the average UK frequency estimate, the mean annual number of deaths was 86 inclusive , 51 intermediate and 21 restrictive. When we repeated the currency conversions using the Bank of England exchange for each financial year, the results were similar. Frequency and cost were presented as total over five years and average annual total for the UK.
Deaths within 30 days of surgery presented as total over five years with average percentage mortality for England, Scotland and Wales. Length of stay presented as annual median for England, Wales and Northern Ireland. The principal finding of this study was that surgery accounts for more than 39 million individual patient episodes in the UK over five years and the annual number of procedures is increasing year on year. The number of procedures is dependent on the definition used, ranging from 7.
This is less than the largest previous estimates of national surgical volume. We are unable to say whether these deaths are attributable to surgery or if they are preventable because these data represent all-cause mortality.
However, it raises questions about whether there are opportunities to intervene in the perioperative care pathway to further patient benefit, and to what degree life expectancy influences the decision of doctors and patients to proceed with invasive procedures. This is the first investigation, of which we are aware, to estimate the total number of surgical procedures across all four nations of the UK.
Our findings are consistent with previous reports, which suggest that between 1. The absence of a standard vocabulary is unhelpful and promotes confusion. We did not include non-instrumental delivery in any category. Our estimates of procedural mortality are consistent with previous estimates 0. However, it is unclear whether this represents a true reduction in mortality, because of improved patient care and perioperative risk assessment, or whether this is a statistical artefact of an increased number of low-risk procedures denominator.
The median length of hospital stay restrictive category was 3. We were unable to investigate the influence of complications on hospital length of stay in this study. This study has several strengths. Therefore, our results represent the majority of surgery undertaken nationally over the 5 yr period of interest, which makes these data generalizable to the entire UK population.
In contrast to previous reports using similar source data, we adopted three transparent consensus categories of surgery to reflect the variety of opinions regarding what constitutes surgery. Our categories of surgery are available in the Supplementary data Tables S2—S5 and we hope others will expand on this work. The mortality data were generated through linkage to the ONS death register. Therefore, the mortality rates represent all deaths in the UK within the allotted time period, not just in-hospital mortality, which has been a key limitation of previous epidemiological studies.
This study also has several limitations. This was an ecological study using group-level data. We were not able to undertake patient-level multivariable statistical modelling or risk adjustment. The accuracy and completeness of data coding, as well as clinical care, is likely to vary between hospitals and between individuals at each hospital, which may introduce information bias.
Where multiple procedures occur in one admission, the hospital episode is coded according to the predominant procedure, so this analysis may underestimate the total number of procedures. The source data represent all hospital procedures provided or funded through the NHS, but does not include procedures provided and paid for privately. We approached private providers in order to estimate the volume of private surgery in the UK, but this was unsuccessful. We prospectively created three categories of surgery and categorized OPCS4 codes by consensus.
This is inherently subjective and not all clinicians or researchers will agree with our interpretation. Restrictions regarding public availability of hospital episode data in Northern Ireland mean that the primary analysis did not include data from Northern Ireland before and the mortality analysis did not include deaths in Northern Ireland.
However, we do not believe this has a significant effect on the generalizability of the results to the UK population. Standard methodology for health economic analysis uses PbR tariff. Finally, we presented the mortality data as crude unadjusted incidence rates because we did not have access to mortality data stratified by age in order to perform age standardization.
As it was not our intention to make comparisons between countries, or make inferences regarding exposures that might influence postoperative mortality, we do not think this influences our interpretation. A very large number of hospital procedures are performed in the UK every year, representing a significant proportion of NHS activity, expenditure and mortality.
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