Inpatient surgical procedures per year per 100 000

Armenia

Source of data: National Health Information Analytic Center, Ministry of Health of the Republic of
Armenia http://moh.am/?section=static_pages/index&id=625&subID=824,29.
Data collected annually, reference period: 31 December.

Belgium

Source: Federal Public Service of Public Health, Food Chain Safety and Environment. Health Care
Facilities Organization (DG1), Minimal Clinical Data for 2007 is provisional.

Cyprus

Public sector general hospitals only.

Czechia

Source: Institute of Health Information and Statistics of CR (IHIS CR). Survey on bed resources of
health establishments and their exploitation. Coverage: Data relates to number of operations
performed in operation theatres in bed care departments of hospitals and specialized therapeutic
institutes.

Estonia

Since 2003 NCSP (NOMESCO Classification of Surgical Procedures), is used, chapters A-H, J-N, P, Q,
Y. In order to provide more comparable data with previous years, the main surgical procedure has
been used for counting the number of operations. Source: annual reporting, National Institute for
Health Development.

Finland

Source: Hospital Discharge Register, THL (National Institute for Health and Welfare).

Georgia

Source: National Centre for Disease Control and Public Health of Georgia (NCDC) (http://www.ncdc.ge)

Germany

Number of in-patients in hospitals undergoing surgical procedures and stay over at least one night.
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 1993 the coverage of hospitals was 96.2%;
in 1994 it was 99.0% and from 1995 it was virtually 100%. Source: Federal Statistical Office,
Hospital statistics - diagnostic data of the hospital patients.

Hungary

Source until 2003: Center for Health Care Information (GYOGYINFOK). The data is the case number of
department discharges. Source from 2004: National Institute for Strategic Health Research (ESKI).

Iceland

The Directorate of Health. Data from 1998-2009 corrected. This was based on OECD shortlist for
inpatient surgery but now the numbers represent all procedures performed as in-patient surgery.
Furthermore, all procedures per stay are counted and not only main/principal procedures (this is in
accordance with OECD and Eurostat definitions).

Ireland

Source: The data presented are derived from the HIPE (Hospital In-Patient Enquiry) data set, which
records data on discharges from all publicly funded acute hospitals. The Economic and Social
Research Institute (ESRI) is contracted by the Health Service Executive (HSE) to manage the HIPE
system. See http://www.esri.ie/health_information/hipe/.

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. It is
estimated that in excess of 10% of all hospital activity in Ireland is undertaken in private
hospitals.
The data coverage in HIPE exceeds 96%, i.e. overall approximately 4% of activity in publicly funded
acute general hospitals is missing from HIPE.

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.e.
excluding deaths and emergency transfers) on the same day. 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
definition is the same as that used in submission of data to the OECD and Eurostat. 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.
Prior to 2005, HIPE data was coded in ICD-9-CM. The ICD-9-CM classification categorized every
procedure as an OR procedure or non-OR procedure. From 2005, HIPE data is coded using ICD-10-AM (the
Australian Modification of ICD-10 incorporating the Australian Classification of Health
Interventions). However in ICD-10-AM there is no comprehensive list of OR or non-OR procedures. For
this reason, the surgical DRG methodology is used for all years.

Break in time series:
Data for 1994-2004 were classified using ICD-9-CM. All HIPE discharges from 2005 are now coded
using ICD-10-AM (the Australian Modification of ICD-10 incorporating the Australian Classification
of Health Interventions). The change from ICD-9-CM to ICD-10-AM has resulted in some minor changes
in the classification of diagnoses and procedures, and a change from HCFA DRGs to Australian Refined
DRGs (ARDRGs). For more information on the introduction of ICD-10-AM in Ireland see
http://www.esri.ie/health_information/hipe/clinical_coding/classifications/.

Israel

Inpatient procedures in acute care hospitals. Source until 1990: based on Diagnostic statistics of
hospitalization, Central Bureau of Statistics and Ministry of Health. Since 1993 based on the
National Hospital Discharges Database, Department of Health Information, Ministry of Health. Day
treatment cases and hospitalisations without overnight stay are not included since 1994.

Italy

Source: Ministry of Health. Data derived from S.D.O. (Scheda Dimissione Ospedaliera) and refer to
all public and private hospitals. Clinical data gathered in the hospital discharges database are
coded with the following versions: until 2005 with ICD9-CM version 1997, from 2006 to 2008 with
ICD9-CM version 2002, since 2009 with the ICD9-CM version 2007.

Lithuania

Source: Up to 2000: LHIC (Lithuanian Health Information Centre) annual report data. From 2001: HI
HIC data from annual reports and Compulsory Health Insurance Database (for day cases).
Coverage: Up to 2000: including day cases. From 2001: excluding day cases.

Montenegro

Data are not available.

Netherlands

Source: Hospital Discharge Register (HDR) of Dutch Hospital Data. From 2005 onwards the HDR in the
Netherlands suffers from a substantial degree of non-response, especially for the reporting of
surgical procedures. Therefore we raised the figures by imputation of data for the non-responding
hospitals. This results in less accuracy of the figures. The inaccuracy is higher for surgical
procedures than for hospital diagnoses because from 2005 onwards some hospitals do register
diagnoses but do not report procedures. In 2004, for only 1% of the discharges did the surgical
procedures have to be imputed. In 2005 it was 13%, in 2006 it was 26% and in 2007 it was 31%. The
figures include the surgical treatments in Dutch hospitals to non-residents of the Netherlands.

Portugal

Source of data: National Statistical Institute Coverage: National

Spain

Source up to 1996: National Statistics Institute and Ministry of Health and Consumer Affairs.
Statistics on Health Establishments Providing Inpatient Care. Source from 1996: Ministry of Health
and Consumer Affairs. (www.msc.es/)

Sweden

Source: National Patient Register NBHW.

Switzerland

The data is restricted to inpatient cases (exclusion of day cases). Source of data: FSO Federal
Statistical Office, Neuchatel; Medical Statistics of Hospitals; yearly census.
Coverage: Full coverage of hospitals; sufficient (nearly full) coverage of inpatient and day cases
since 2002. Due to a modification of the legislation, day cases are not collected in 2009 anymore.
Deviation from the definition:
Estimation method: Discharges without a valid ICD-code are not accounted for (negligible).
Break in time series: The gradual change of diagnosis classification since 2008 from ICD-10 WHO to
ICD-10 GM (German Modification) may lead to breaks for some categories.

Türkiye

Source: General Directorate of Curative Services. Method: Total surgical interventions also include
the number of daily surgical interventions.

Turkmenistan

Source: Administrative medical statistics, forms: 14 ?Report on hospital activity?, 008/y ?Journal
for surgeries? records? and 066/y ?Hospital discharge record?.

Ukraine

For inpatient institutions under Ministry of Health.
Source: Centre of Health Statistics, Ministry of Health

United Kingdom

Source of Data: England - NHS Information Centre.
Scotland - NHS National Services Scotland, Information Services Division (ISD).
Wales - NHS Wales Informatics Service (NWIS), Figures based on Welsh Trusts.
N.Ireland - Department for Health, Social Services and Public Safety.

Coverage: Data relates to NHS activity or NHS commissioned activity in the independent sector.
Includes any mention of operation procedure between OPCS codes 'A00' and 'X97' but not between 'O11'
and 'O14' (site codes). Years are based on episode end year.
Scotland - 2010 data are affected by data submission issues that we have encountered, so they
should be regarded as provisional and potentially incomplete.ÿ
We are also aware of a specific hospital where the SMR01 returns from November 2010 onwards were
missing their operation codes.ÿ This will also be a factor.

Finally, from 1 April 2008, it was no longer mandatory to record 'non-operative'
interventions/procedures (such as imaging, injections, infusions, x-rays, etc) unless the patient is
specifically admitted for this purpose. Therefore this will also impact on figures for 2008
onwards.ÿ For further details about this please refer to the Clinical Coding Guidelines (March 08
No.22) (page 6).


Deviation from the Definition: There is no agreed list of OPCS procedure codes from which the UK
can accurately identify surgical procedures. As such the data provided is for total inpatient
procedures.

Break in Time Series: Data from 2000 onwards is not comparable with data from prior to this. This
is due to work conducted to improve compliance with definitions and consistency of methodologies
across the four parts of the UK.
2010 - All data is financial year data with the exception of Scotland whose data is calendar year.