Surgical procedures

DEFINITIONS

Age group — in health care statistics a child is considered to be a person aged 0 to 14 years, while an adult is a person aged 15 years and older.

Average annual population — half the sum number of the population at the beginning and the end of the year. This index is used to calculate rates.

County — location of health care service provider in the tables KP12, KP32, KP42 and patient's place of residence in the table KP15. It is classified according to the Classification of Administrative and Settlement Units of Estonia (EHAK) (see classifications). Until 2017, data by the counties is distributed by the administrative division that existed before administrative reform (October 2017). Data starting from 2018 is distributed by new administrative division.

Emergency surgery — surgery service provided by a health care service provider in a situation where a delay in medical assistance or lack of its provision may cause death or permanent injury to the health of the person requiring care. The service is classified according to the diagnosis on the basis of ICD-10. Only selected „acute abdomen“ data are collected and presented.

Health care provider or health care facility — a legal person whose principal or ancillary activity is to provide health care services. Health care providers (except family doctor's offices) must have an activity licence issued by the Health Board (Health Care Board until 1 January 2010).

Health care service — activities of health care personnel (doctor, dentist, nurse, midwife), aimed at preventing, diagnosing or curing a disease, an injury or poisoning, at alleviating human suffering, at preventing the state of health of a patient from worsening or exacerbating and at improving the patient’s health. Health care services are divided into three types: outpatient health care service, or outpatient care, day care and inpatient health care service, or hospital care.

Main surgical procedure — the largest and the most resource-consuming procedure out of several simultaneously carried out procedures. Simultaneously carried out procedures are ranked according to their importance if there is no corresponding code for a complex procedure.

Operated — patient is counted only once per discharge by main procedure. For example if appendectomy and ileocaecal resection is done per one discharge and by surgeon's opinion the main procedure is ileocaecal resection, patient is counted as operated because of "ileocaecal resection".

Procedures — the number of surgical procedures includes both main and other procedures. If the same procedure is noted twice in one day, it is counted twice in the tables KP11–KP33, KP51. In the table KP15 operations are counted once per procedure category for each patient. But if a patient gets the same procedure at different moments in a given year, then is counted repeatedly.

Type of provider of health care services — health care providers are divided into the following types: hospitals, family doctor's offices, specialist health care providers, dental care providers, emergency medical care providers, rehabilitation care providers, diagnostics providers, nursing care providers and other providers (see classifications).

METHODOLOGY

The aim of the collection and production of surgical procedure statistics is to get an overview of the volume of surgical work done by health care service providers in accordance with the way the service is rendered, the type of institution, the county, patient's age and sex.

The data are collected from institutions providing health care services which hold a relevant activity licence and from family physicians working with practice lists in accordance with the Health Care Services Organisation Act (HCSOA) and decree by the Minister of Social Affairs on the basis of the HCSOA.

Surgical procedures statistics must be submitted by outpatient, day care and inpatient surgical service providers.

The following report forms serve as the basis for the production of surgical procedures statistics:

The data about all procedures coded on the basis of NCSP main chapters A–H, J–N, P, Q and subsidiary chapters T, Y has been collected. The total number of surgical procedures includes both main and follow-up procedures.

The data about emergency surgery is submitted according to the diagnosis on the basis of ICD-10. Only selected „acute abdomen“ data are collected and presented.

 

Correspondence of NCSP codes in tables KP11, KP12, KP13, KP21

Procedure NCSP code
All operations A-Q, Y
Nervous system operations A
..Skull and spinal cord AA, AB
....Disc pathology (2003–2009) ABC01-26
....Disc pathology (since 2010) ABC01-28
..Peripheral nervous system AC
Endocrine system operations B
..Thyroid gland BA
..Parathyroid gland and adrenal gland BB, BC
Eye operations C
..Glaucoma CHB, CHD, CHF30
..Cataract (2003–2009) CJB, CJC, CJD, CJE, CJF00, CJF10, CJF40, CJF45, CJF50, CJF55, CJG10, CJG15, CJG20, CJG25
..Cataract (since 2010) CJA00, CJA10, CJB, CJC, CJD, CJE, CJF00, CJF10, CJF40, CJF45, CJF50, CJF55, CJG10, CJG15, CJG20, CJG25
..Intraocular foreign bodies and perforating injuries CDB, CGC, CGF
Ear, nose and larynx operations D
..Nose DH, DJ, DL, DK
..Sinus DM, DN, DP
..Larynx DQ
..Ear DA-DG
Teeth, jaws, mouth and pharynx operations E
..Cleft lip, cleft palate (2003–2009) EHC40,50,60
..Cleft lip, cleft palate (since 2010) EHC31,32,40,50,60
..Jaws ED-EG
..Excision of tonsils and adenoids EMB10,20,30
Heart and major thoracic vessels operations F
..Coronary arteries FNA, FNB, FNC, FNE, FNG, FNH, FNK, FNW
....Coronary bypass FNA, FNB, FNC, FNE
....Percutaneous transluminal coronary angioplasty FNG02,05
..Valves FGC, FGE, FKA, FKB, FKC, FKD, FKW, FMA, FMC, FMD, FMW
..Thoracic aorta FCA, FCB, FCC
..Permanent cardiac pacemaker FPE, FPF, FPG, FPH, FPJ
Respiratory tract operations G
..Lung GD
Mammary gland operations H
..Mastectomy HAC
..Partial excision of mammary gland HAB40,99
Digestive system and spleen operations J
..Laparotomy JAH00,20,30,33,40, JAK00,03,10, JAL10
..Herniotomy JAB - JAG, JBB
....Inguinal hernia JAB
....Femoral hernia JAC
..Stomach and duodenum JD
....Partial gastrectomy JDC
....Total gastrectomy JDD
....Vagotomy JDG
....Other stomach operations JDA, JDB, JDE, JDF, JDW
..Appendectomy JE
..Small and large intestine JF
....Small intestine JFA0*,2*,3*,60,7*, JFB0*,1*, JFC0*, JFD, JFE, JFF0*,1*, JFG00,2*,53,60,70,73,80,86
..Rectum JG, JH
..Cholecyst, biliary tract, liver and pancreas JJ, JK, JL
....Cholecystectomy JKA20
....Laparoscopic cholecystectomy JKA21
....Biliary tract JKB, JKC, JKD, JKE, JKF, JKT, JKW
....Pancreas JL
..Spleen JM
Urinary system, male genital organs and retroperitoneal space operations K
..Endoscopic operation of kidney, pelvis of kidney and ureter KA**, KB** fifth place except 0,3,6
..Extracorporeal shock wave lithotripsy KAT, KBT, KCT
..Nephrolithotomy, pyelolithotomy, ureterotomy in case of calculi KAE00,10,96, KBE00,96
..Transplantation of kidney KAS00,10,20
..Radical cystectomy KCC
..Transurethral resection of bladder KCD02
..Radical prostatectomy KEC
..Partial excision of prostate using the open method KED00,96
..Partial transurethral excision of prostate KED22,52,62,72,98
..Other prostate operations KEA, KEB, KEE, KEV, KEW
..Other andrological operations KF, KG
Female genital organs operations L
..Uterus LC, LEF13
....Laparoscopic operation LCA01, LCB01,11,14,97, LCC01,11,97, LCD01,04,11,31,97, LCF01,11,97, LCG11,21,31,41,97
....Hysteroscopic operation LCA22, LCB25, LCB28, LCB98, LCC05, LCG02, LCG98, LCW98
....Hysterectomy LCC, LCD, LCE, LEF13
....Total excision of uterus LCD00,10,30,40,96, LEF13
....Supravaginal hysterectomy LCC10,20
....Myomectomy LCB 10,20
....Reconstructive operation LCG10,20,30,40,96
....Curettage of body of uterus LCA10,13
....Termination of pregnancy LCH
..Cervix LD
..Ovary LA
....Open and other ovary operations (2003–2009) LAA00,03,96, LAB00,10,96, LAC00,10,20,30,96, LAD00, LAE10,20, LAF00,10,20, LAG00,10,20,96, LAW96
....Open and other ovary operations (since 2010) LAA00,03,96, LAB00,10,96, LAC00,10,20,30,96, LAD00, LAE10,20, LAF00,10,20,30, LAG00,10,20,96, LAW96
....Laparoscopic ovary operations LAA01,11,97, LAB01,11,21,97, LAC01,11,21,31,97, LAD01, LAE11,21, LAF01,11 LAG01,11,21,97, LAW97
..Fallopian tube LB
....Open and other Fallopian tube operations LBA00,03,96, LBB00,96, LBC00,10,20,96, LBD00, LBE00, LBF00,20,30,40,50,60,70,96
..Laparoscopic Fallopian tube operations LBA01, LBA97, LBB01,11, LBC07,11,21,97, LBD01, LBE01, LBF01,11,31,41,51,61,97, LBW97
....Laparoscopic operation for tubal pregnancy LBC07,11,21,97, LBD01, LBE01
..Vagina LEA10, LEB, LEC, LED, LEE, LEF00,10,20,23,40,50,53,96, LEG, LEW96
....Laparoscopic vaginal operations LEF41,51,97, LEW97
..Laparoscopic female sterilisation LGA11,21,97
Obstetric operations M
..Caesarean section MCA
Musculoskeletal operations N
..Fracture surgery NBJ, NCJ, NDJ, NEJ, NFJ, NGJ, NHJ
....Humerus NBJ01,11,21,31,41,51,61,71,81,91
....Ulna NCJ
....Femur NFJ
....Tibia NGJ
..Amputation of limb NCQ19, NFQ19,29,99, NGQ19,29,99, NHQ14,15,17
....Amputation of femur, lower leg NFQ19,29,99, NGQ19,29,99
..Arthroscopic operation NBA*1, NBE*1, NBF*1, NBH*1, NCA*1, NCE*1, NCF*1, NCH*1, NDA*1, NDE*1, NDF*1, NDH*1, NEA*1, NFA*1, NFE*1, NFF*1, NFH*1, NGA*1, NGD*1, NGF*1, NGH*1, NHA*1, NHF*1, NHH*1, NGE*5, NGE*6
....Arthroscopic knee operation NGA11
....Arthroscopic operation of meniscus of knee NGD01, NGD11, NGD21, NGD91
..Arthrotomy, arthroplasty, arthrodesis NBG, NCG, NDG, NEG, NFG, NGG, NHG
..Prosthetic replacement NBB, NBC, NCB, NCC, NDB, NDC, NEB, NEC, NFB, NFC, NGB, NGC, NHB, NHC
..Total prosthetic replacement of hip joint NFB20,30,40, NFC20,30,40
Peripheral vessels and lymphatic system operations P
..Restorative artery operation PAC, PAF, PAG, PAJ, PAK, PAN, PBC, PBF, PBG, PBH, PBN, PCC, PCF, PCG, PCH, PCJ, PCK, PCN, PDC, PDF, PDG, PDH, PDN, PEC, PEF, PEG, PEH, PEN, PFC, PFG, PFH, PFN, PGH
..Restorative artery operation (since 2017) PAC, PAF, PAG, PAJ, PAK, PAN, PBC, PBF, PBG, PBH, PBN, PCC, PCF, PCG, PCH, PCJ, PCK, PCN, PDC, PDF, PDG, PDH, PDN, PEC, PEF, PEG10-12, PEH, PEN, PFC, PFG, PFH, PFN, PGH10-99
..Operation for thrombectomy and embolectomy PAE, PBE, PCE, PDE, PEE, PFE
..Other artery operation (2003–2009) PAA, PAB, PAH, PAM, PAP-PAW, PBA, PBB, PBL, PBM, PBP-PBW, PCA, PCB, PCP-PCW, PDA, PDP-PDW, PEA, PEP-PEW, PFA, PFB, PFL, PFP-PFW, PGU, PGW
..Other artery operation (2010–2016) PAA, PAB, PAH, PAM, PAP-PAW, PBA, PBB, PBL, PBM, PBP-PBW, PCA, PCB, PCP-PCW, PDA, PDP-PDW, PEA, PEL10, PEM10, PEP-PEW, PFA, PFB, PFL, PFP-PFW, PGU, PGW
..Other artery operation (since 2017) PAA, PAB, PAH, PAM, PAP-PAW, PBA, PBB, PBL, PBM, PBP-PBW, PCA, PCB, PCP-PCW, PD1AT, PDA, PDP-PDW, PE1AT, PEA, PEG00, PEL10, PEM10, PEP-PEW, PFA, PFB, PFL, PFP-PFW, PGA, PGB, PGG, PGH00, PG1ST, PGU, PGW, PGX
..Varicectomy and other vein operations (2003–2016) PHD
..Varicectomy and other vein operations (since 2017) PHD10,11,12,15,99
..Lymphatic system PJ
Skin and subcutaneous tissue operations Q
Excision of organs or tissue for transplantation Y

ABC28, CJA00,10, EHC31,32, LAF30, PEL10, PEM10 are in use since 2010.

 

Correspondence of NCSP codes in tables KP31, KP32, KP33

Procedure NCSP code
All operations and procedures A-Q, T
All operations A-Q
Nervous system operations A
Minor neurosurgical procedures TA
Endocrine system operations B
Minor procedures in endocrine surgery TB
Eye operations C
..Cataract (2003–2009) CJC, CJD, CJE, CJF00,10,40,45,50,55, CJG10,15,20,25
..Cataract (since 2010) CJA00,10, CJC, CJD, CJE, CJF00,10,40,45,50,55, CJG10,15,20,25
Minor procedures in eye surgery TC
Ear, nose and larynx operations D
Minor procedures in ear, nose and larynx surgery TD
Teeth, jaws, mouth and pharynx operations E
..Pharynx, adenoids, tonsils EM, EN
Minor procedures in teeth, jaws, mouth and pharynx surgery TE
Heart and major thoracic vessels operations F
Minor procedures in cardiac surgery TF
Respiratory tract operations G
Minor procedures in thoracic surgery TG
Mammary gland operations H
Minor procedures in mammary gland surgery TH
Digestive system and spleen operations J
Minor procedures in gastroenterological surgery TJ
Urinary system, male genital organs and retroperitoneal space operations K
Minor surgical procedures on urinary organs TK
Female genital organs operations L
..Termination of pregnancy LCH
Minor procedures in gynaecology TL
Obstetric operations M
Minor procedures in obstetrics TM
Musculoskeletal operations N
Minor procedures in orthopaedic surgery TN
Peripheral vessels and lymphatic system operations P
..Peripheral vessels operations PA-PH
Minor procedures on peripheral vessels and lymphatic system TP
Skin and subcutaneous tissue operations Q
Minor procedures on skin TQ

 

Since 2017 inpatient and day care surgery by patient’s county (data source: e-health) is presented in KP15.

Definition of e-health data operation differs from definition of surgery which data source is aggregated reports from health care providers. In the table KP15 operations are counted once per procedure category for each patient. But if a patient gets the same procedure at different moments in a given year, then is counted repeatedly.

Correspondence of NCSP codes in table KP15

Procedure NCSP code
Discectomy ABC01–ABC28
Peripheral nerve surgery AC
Thyroidectomy BAA20–BAA60
Glaucoma surgery CHB, CHD, CHF30
Cataract surgery CJA00,10, CJC, CJD, CJE, CJF00,10,40,45,50,55, CJG10,15,20,25
Tonsillectomy and/or adenoidectomy EMB10–EMB30
Coronary artery bypass graft FNA, FNB, FNC, FNE
Transluminal coronary angioplasty FNG02, FNG05, EHIF health care service codes 7655, 7656
Mastectomy HAC
Partial excision of mammary gland HAB40, HAB99
Repair of inguinal hernia JAB
..Laparoscopic repair of inguinal hernia JAB11, JAB97
Appendectomy JEA
..Laparoscopic appendectomy JEA01
Cholecystectomy JKA20, JKA21
..Laparoscopic cholecystectomy JKA21
Open prostatectomy KEC, KED00, KED96
Transurethral prostatectomy KED22, KED52, KED62, KED72, KED98
Hysterectomy LCC, LCD, LCE,
Caesarean section MCA
Amputation on femur and lower leg NFQ19, NFQ29, NFQ99, NGQ19, NGQ29, NGQ99
Arthroscopic excision of meniscus of knee NGD01, NGD11, NGD21, NGD91
Hip replacement NFB, NFC
Knee replacement NGB, NGC
Ligation and stripping of varicose veins-lower limb PHD10, PHD11, PHD12, PHD15, PHD99

CLASSIFICATIONS

Classification of Administrative and Settlement Units of Estonia (EHAK)

This classification is used upon submission of regional statistics. Regional health care statistics are submitted by 15 counties. Information about Tallinn and Tartu is submitted separately. Until 2017, data by the counties is distributed by the administrative division that existed before administrative reform (October 2017). Data starting from 2018 is distributed by new administrative division. This classification system is available on the webpage of the Statistics Estonia in the Classifications section.

 

Classification of hospitals

On the basis of the services they provide hospitals are divided into seven types: regional hospitals, central hospitals, general hospitals, local hospitals, special hospitals, rehabilitation hospitals and nursing care hospitals. Requirements for different hospital types are laid down in Decree No. 103 Requirements for Hospital Types (in Estonian), issued by the Minister of Social Affairs on 19 August 2004.

 

Surgical procedures classification NOMESCO (NCSP), (vs 1.6: 2003–2009, vs 2010: 2010–2011, vs 2012: 2012–2013, vs 2014, vs 2016).

This classification is used to code and submit surgical procedures. The classification is available on the webpage of the Health and Welfare Information Systems Centre (in Estonian).

 

The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)

This classification is used to code diagnoses and submit the data about disease cases in accordance with the diagnoses. The classification system is available on the webpage of the World Health Organization.

 

Classification of health care service providers

On the basis of the type of provided health care service the health care service providers are divided in the following way:

The health care service providers mentioned above are classified in descending order of rank, i.e., if one facility provides several health care services, it is classified as an facility providing a relevant service mentioned afore in the list.

PUBLICATIONS

National Institute for Health Development of Estonia, The National Health Service of Latvia, Health Information Centre, Institute of Hygiene, Lithuania (2018). Health in the Baltic Countries 2016. Tallinn: National Institute for Health Development. Report is available here in pdf-format

National Institute for Health Development of Estonia, The National Health Service of Latvia, Health Information Centre, Institute of Hygiene, Lithuania (2017). Health in the Baltic Countries 2015. Tallinn: National Institute for Health Development. Report is available here in pdf-format

National Institute for Health Development of Estonia, The National Health Service of Latvia, Health Information Centre, Institute of Hygiene, Lithuania (2016). Health in the Baltic Countries. 2014. Tallinn: National Institute for Health Development. Report is available here in pdf-format

CONTACT

Merike Rätsep

Department of Health Statistics

National Institute for Health Development

Phone: +372 659 3817

E-mail: Merike.Ratsep[at]tai.ee

 

Updated: 10.10.2019