Elective surgery activity

From February 2020, a range of restrictions on travel, business, social interaction and border control, and also other interventions and initiatives were introduced at varying times by the federal and state/territory governments to respond to the COVID-19 virus pandemic.

Some of these restrictions were aimed at reducing the spread of the COVID-19 virus while others focused on ensuring the health system maintained adequate capacity to deal with the pandemic.

In terms of elective surgery, following a decision by National Cabinet, restrictions applied to selected elective surgeries from 26 March 2020 including:

• Temporary suspensions of all urgency Category 3 procedures and selected urgency Category 2 procedures.
• ​No restrictions applied to Category 1 procedures and exceptional Category 2 procedures.
• Similar restrictions on elective surgery were in place through the private sector.

In the following months, in consultation with the Australian Government via National Cabinet, states and territory applied a range of measures to control the rate of elective surgeries and avoid overwhelming the hospital system. Broadly, restrictions began to ease from 27 April, including the re-commencement of Category 2 and selected Category 3 procedures, however, this varied between jurisdictions.

This section presents new analyses on public hospital admissions from elective surgery waiting lists during this period to assess the impact of COVID-19 on elective surgery activity. Some data relating to surgeries provided through the private sector funded by the Medicare Benefits Scheme can be found here.

Explore the data

The data visualisation shows weekly admissions over the 2019–20 period by:

• state and territory
• urgency category
• surgical specialty
• indicator procedure.

​Data are also presented for 2018–19 for comparative purposes.

Highlights

Nationally, in previous years, the number of admissions was generally increasing.

• Between 2017–18 and 2018–19, the number of admissions from public hospital elective surgery waiting lists increased by 1.2%.
• Over the five years prior, from 2014–15 to 2018–19, the number of admissions increased, on average, 2.1% per year.

The data visualisation shows the reduction in admissions from public hospital elective surgery waiting lists during 2019–20.

Compared to 2018–19, in 2019–20:

• elective surgery admissions dropped by 9.2%
• additions to public hospital waiting lists declined by 6.2%.

This suggests that there was a large number of elective surgeries that were delayed and/or where alternative treatment means were chosen during the period. It is unclear at this point what the health impacts of these delays or alternative treatments were.

During the peak of the COVID-19 restrictions in 2019–20, the number of public hospital elective surgeries performed ranged from 15,300 in the week commencing 16 March to 4,800 in the week beginning 13 April 2020.

Urgency of procedure

Compared to 2018–19, in 2019-20:

• people admitted for Category 1 procedures increased by 3.5%
• people admitted for Category 2 procedures remained stable
• people admitted for Category 3 procedures dropped by 3.5%. 

While the number of elective surgeries performed declined from March to June 2020, the proportion of Category 1 and Category 2 procedures undertaken increased as a proportion of the total (reflecting the targeted nature of the restrictions toward lower urgency procedures).

After restrictions eased on elective surgeries, the number of procedures performed began to gradually increase. In the week commencing 22 June, 14,200 procedures were performed, including 4,300 Category 3 procedures.

Surgical speciality

Compared to 2018–19, the surgical specialties that showed the greatest decrease in admissions in 2019–20 were Otolaryngology, head and neck surgery (15.3%), Ophthalmology surgery, eye and optic nerve surgery (14.6%), and Orthopaedic surgery (13.9%).

Type of procedure

Coronary artery bypass graft was the only intended procedure for which admissions from elective surgery waiting lists increased in 2019–20.

Since 2018–19, the intended procedures with the greatest decrease in admissions were:

• varicose veins treatment (29.5%)
• myringotomy (25.5%), a surgery performed on the eardrum to relieve pressure caused by built-up fluid.
• tonsillectomy (22.3%), removal of the tonsils.

It should be noted that, between 2017–18 to 2018–19, these intended procedures also decreased in the number of admissions from elective surgery waiting lists, but at a slower rate:

• varicose veins treatment (4.6%)
• myringotomy (1.4%)
• tonsillectomy (6.6%).

More information about the data

What other information is available on COVID-19?

To explore the influence of the COVID-19 on other health data, further releases are available on the AIHW website under COVID-19 Resources and The impact of COVID-19 on Australia's health system.

Information on the total confirmed cases and active cases can be found on the Australian Government Department of Health website.

What other information is available?

To explore admissions from public hospital elective surgery waiting lists by hospital or LHN see My local area.

Appendixes and caveat information for this data is available to download in the Info and downloads section.

Definitions of the terms used in this section are available in the Glossary.

Elective surgery activity is measured by the number of additions to and removals from public hospital elective surgery waiting lists, and the number of patients admitted for their awaited procedure.

Explore the data

This data visualisation below presents information on additions, removals and admissions in 2019–20 and changes between 2015–16 and 2019–20.

Information is also presented by:

• Indigenous status
• Type of hospital (peer group)

National trends

Additions

• In 2019–20, 837,800 patients were added to elective surgery waiting lists in Australia—this was 6.2% less than in 2018–19 due to the cancellation of non-urgent elective surgeries, as part of COVID-19 restrictions.
• Although the rate of patients added to waiting lists was lower in the past year, the annual increase in the number of patients added to elective surgery waiting lists was, on average, 2.5% per year between 2014–15 and 2018–19.

Removals

Between 2014–15 and 2018–19, the total number of removals from public hospital elective surgery waiting lists increased, on average, by 2.3% each year.

In 2019–20,

• 815,400 patients were removed from public hospital elective surgery waiting lists, which was 8.0% lower than in 2017–18 due to the cancellation of on non-urgent elective surgeries.
• Most patients (84%) were removed from waiting lists were admitted for their awaited procedure.
• 16% were removed from waiting lists for other reasons (for example, the surgery was no longer required, they were treated elsewhere, transferred to another hospital’s waiting list, were unable to be contacted, or died).

Admissions

Between 2014–15 and 2018–19, admissions increased, on average, by 2.1% per year, however, in 2019–20, admissions from waiting lists was 9.2% lower than 2018–19, due to cancellation of non-urgent elective surgery.

In 2019–20,

• there were 688,300 admissions from public hospital elective surgery waiting lists, 99% of which were elective admissions.
• Principal referral and women’s and children’s hospitals and Public acute group A hospitals accounted for three‑quarters of these admissions (41% and 34%, respectively).
• 3.8% of admissions from public hospital elective surgery waiting lists (28,300) were reported for people of Aboriginal and Torres Strait Islander origin who represent about 3.3% of the Australian population. 

The surgical speciality describes the area of clinical expertise held by the doctor performing the elective surgery. This section presents information on the type of elective surgery provided, by surgical speciality in 2019–20 and changes between 2015–16 and 2019–20

Information on 11 categories of surgical speciality is presented. The ‘other’ category contains data for surgeons whose speciality was not one of the 11 specified categories. From 1 July 2016, surgical speciality was revised to include Paediatric surgery.

Explore the data

The data visualisation below presents elective surgery waiting list additions, removals and admissions by state and territory between 2015–16 and 2019–20.

National trends

In 2019–20:

• Around 21% of patients were admitted for General surgery (on abdominal organs, including endocrine surgery and breast surgery).
• About 14% were admitted for Orthopaedic surgery (on bones, joints, ligaments and tendons, including knee and hip replacements) and Urological surgery (on organs of the urinary system such as bladder, urethra and kidneys).

Changes over time

Between 2015–16 and 2019–20:

• Admissions from elective surgery waiting lists decreased for 8 of the 11 surgical specialities.
• The procedures with the greatest average annual decrease were Otalaryngology, head and neck surgery (decreasing by 4.0% per year on average), Orthopaedic surgery (3.7%) and General surgery (3.1%).
• There was an average annual increase in admissions for Urological surgery (2.5%) and Plastic and reconstructive surgery (2.0%).

The intended surgical procedure describes the type of elective surgery provided by public hospitals.

Explore the data

In the data visualisations below, you can explore admissions from elective surgery waiting lists by:

• The list of 15 indicator procedures between 2015–16 and 2019–20.
• Intended surgical procedure, by type of hospital (peer group) and over time between 2015–16 and 2019–20. Waiting times are presented at national, state and territory, LHN, and hospital level.

National trends

In 2019–20:

• 33% of admissions were for the 15 indicator procedures.
• Cystoscopy was the most commonly reported intended surgical procedure with about 60,800 patients admitted, followed by Cataract extraction (60,200).

Changes over time

Between 2015–16 and 2019–20:

• Admissions from elective surgery waiting lists increased for 12 of the 15 indicator procedures.
• The indicator procedures with the greatest average annual decreases were Varicose veins treatment (10.8%) and Tonsillectomy (6.0%).
• Admissions increased for Cystoscopy (4.8% per year on average) and Prostatectomy (1.1%).

Between 2018–19 and 2019–20:

• There were relatively large decreases in admissions for Varicose veins treatment  (29.5%) and Myringotomy (25.5%).