Elective surgery activity

Since early 2020, restrictions on the conduct of some elective surgeries have been implemented at various times as part of Australia’s response to the COVID-19 pandemic. Initially, these restrictions were applied nationally, although as different states, territories and regions managed outbreaks over the following years, restrictions have applied to different geographic regions and at different times. These restrictions have had effects on the volume, type and timing of elective surgery procedures undertaken.

These restrictions have primarily aimed to ensure the health system maintained adequate capacity to respond to the needs of people requiring acute care as a result of COVID-19. However, at other stages of the COVID pandemic, the restrictions have reflected disruptions to the delivery of hospital services due to COVID infections which have affected staff and patients and the availability of resources (e.g. ICU beds).

This section presents analyses on public hospital admissions from elective surgery waiting lists over the 2019–20 to 2021–22 period to assess the impact of COVID-19 on elective surgery activity. 

Explore the data

The data visualisation shows monthly admissions from 2019–20 to 2021–22 by:

• state and territory
• urgency category
• surgical specialty
• selected intended procedure, previously known as indicator procedures.

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

Highlights

Nationally, between 2014–15 and 2018–19, the number of admissions for elective surgery increased by 2.1% on average each year.

In 2019–20, there was a reduction in admissions from public hospital elective surgery waiting lists associated with the initial introduction of restrictions that applied nationally. Compared with 2018–19, in 2019–20:

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

During the peak of the COVID‑19 restrictions in 2019–20, the number of public hospital elective surgeries performed per month decreased from 58,200 in March to 26,500 in April.

In 2020–21, following the decrease in admissions from elective surgery waiting lists in the previous year, admissions increased by 9.6%. This increase was not consistent across all jurisdictions. Many jurisdictions saw the number of admissions in 2020–21 exceed that of 2019–20 with most, but not all, jurisdictions’ admissions exceeding pre-COVID numbers.

However, in 2021–22, which saw a dramatic increase in COVID–19 case numbers and hospitalisations across many parts of Australia, all jurisdictions except Tasmania saw a reduction in elective surgery admissions. Nationally, compared to 2020–21, admissions from elective surgery waiting lists declined by 17% (from 754,600 to 623,000) – with the largest decreases seen in New South Wales (27% reduction; from 251,000 to 182,900) and Western Australia (23% reduction; 92,400 to 71,000).

Urgency of procedure

Compared with 2020–21, in 2021–22:

• people admitted for Category 1 procedures decreased by 2.2%
• people admitted for Category 2 procedures decreased by 17%
• people admitted for Category 3 procedures decreased by 32%.

In January 2022, there was a considerable decline in Category 3 procedures, most likely due to disruptions to the delivery of hospital services as a result of rising COVID case numbers and hospitalisation.

Surgical speciality

Compared to 2018–19, in 2019–20, the surgical specialties that showed the greatest decrease in admissions were Otolaryngology, head and neck surgery (15%), Ophthalmology surgery (eye and optic nerve surgery) (15%), and Orthopaedic surgery (14%). In 2020–21, most surgical specialties saw an increase in admissions except for Cardiothoracic surgery (4.4% decrease).

However, in 2021–22, there were decreases in admissions from public hospital elective surgery waiting lists across all specialties. The surgical specialties with the greatest decrease in admissions were:

• Otolaryngology, head and neck surgery (24%)
• Orthopaedic surgery (23%)
• Ophthalmology surgery (19%).

Type of procedure

In 2021–22, the number of admissions from public hospital elective surgery waiting lists decreased across all selected intended (indicator) procedures, when compared with 2020–21. The procedures with the greatest decrease were:

• Tonsillectomy (35%)
• Varicose veins treatment (34%)
• Total knee replacement (33%).

Elective surgery waiting list 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 data for 2021–22 and recent years.

The data can also be explored:

• nationally, for additions to waiting lists and reason for removal
• by Local Hospital Network (LHN) (where data is available)
• by hospital (where data is available).

Highlights

Admissions from elective surgery waiting lists

Overall, in 2021–22:

• There were 623,000 admissions from public hospital elective surgery waiting lists – 99% of which were elective admissions for the intended procedure. The remaining 1% were admitted as emergency patients because the patient’s condition deteriorated or for other reasons.
• Of the 623,000 admissions, 228,500 (37%) were Category 1, 229,200 (37%) were Category 2, and 165,300 (26%) were Category 3.
• Principal referral and women’s and children’s hospitals and Public acute group A hospitals accounted for approximately three‑quarters of all admissions from elective surgery waiting lists (40% and 34%, respectively).
• 4.2% of admissions from public hospital elective surgery waiting lists were for people reported as being of Aboriginal and/or Torres Strait Islander origin who represent 3.8% of the Australian population.

In 2021–22, admissions from elective surgery waiting lists decreased overall by 17% compared with 2020-21, likely due to COVID-19 restrictions and limitations on hospital services during this period.

This contrasts with the change in the previous year, where admissions increased overall by 9.6% between 2019–20 and 2020–21. In the year prior, 2019–20, which was the first year of restrictions due to COVID-19, there was an overall reduction of elective surgeries admissions by 9.2% compared with 2018–19. In the years preceding this period, the number of admissions increased annually on average by 2.1% from 2014–15 to 2018–19.

The change in the number of elective surgery admissions, from 2020–21 to 2021–22, was not uniform across Australia. In NSW, admissions decreased by 27%, while admissions increased in Tasmania by 11%. This is likely due to the disproportionate impact COVID-19 had on each state and territory.

Additions to elective surgery waiting lists

In 2021–22, 783,700 patients were added to elective surgery waiting lists in Australia – a 12% decrease from the number of patients added in 2020–21. However, it should be noted that:

• The number of patients added in 2020–21 (893,200) was a 6.6% increase in the number of additions from the previous year and was affected by the easing of restrictions placed on elective surgery and healthcare services more generally in the previous year.
• In the 5 years prior to 2018–19, the number of additions to elective surgery waiting lists increased, on average, by 2.5% each year.

Removals from elective surgery waiting lists

In 2021–22:

• 759,100 patients were removed from public hospital elective surgery waiting lists –  a decrease of 16% compared with 2020–21.
• Most patients removed from waiting lists (82%) were admitted for their intended procedure.
• 17% 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).

The 16% decrease in removals in 2021–22 followed an 11% increase in 2020–21, which in turn, was followed by an 8.0% decrease in removals in 2019–20. This fluctuating pattern in recent years is likely due to restrictions and limitations in services that were able to be provided in response to COVID-19 outbreaks at different periods over these three years. In the years before COVID-19, the total number of removals from waiting lists increased on average by 2.3% each year between 2014–15 and 2018–19.

In 2021–22, there was an 11.5% decrease in patients removed from elective surgery waiting lists due to being transferred to another hospital’s waiting list, compared with 2020–21. In comparison, the change in the previous corresponding period was an increase of 40%; and in the year prior, it increased by 20%. The increase in these previous two years were possibly due in part, to management of waiting lists during COVID-19.  

The surgical speciality describes the area of clinical expertise held by the doctor scheduled to perform the elective surgery. This section presents information on the type of elective surgery provided, by surgical speciality, in 2021–22 and changes over recent years.

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.

This data visualisation below presents data for 2021–22 and recent years.

 The data can be explored:

• nationally or by state/territory, by surgical speciality
• by Local Hospital Network (LHN) (where data is available)
• by hospital (where data is available).

The continuation of restrictions on elective surgery admissions across some jurisdictions and the overall impact of the COVID–19 pandemic in recent years should be considered when interpreting this data.

Highlights

In 2021–22, of the 623,000 admissions from elective surgery waiting lists:

• 21% were for General surgery (on abdominal organs, including endocrine surgery and breast surgery). This was the most common surgical specialty resulting in an admission from a waiting list.
• 16% were for Urological surgery (on organs of the urinary system such as bladder, urethra, and kidneys) and 13% were for Orthopaedic surgery (on bones, joints, ligaments, and tendons, including knee and hip replacements).

Changes over time

• Between 2020–21 and 2021–22, overall admissions from elective surgery waiting lists decreased by 17%, whereas between 2017–18 and 2021–22, it decreased by 4.5%.
• Between 2020–21 and 2021–22, Otolaryngology, head, and neck surgery and Orthopaedic surgery had the largest decrease in admissions by 24% and 23% respectively. This was much lower between 2017–18 and 2021–22, where it decreased by 8.0% and 6.9% respectively.
• Between 2020–21 and 2021–22, Paediatric surgery and Plastic surgery had the smallest decrease in admissions by 8.6% and 9.1% respectively, while between 2017–18 and 2021–22, it decreased by 1.6% and 2.2% respectively.

In general, those surgical specialties with the largest decreases between 2018–19 and 2019–20 had the greatest increase in admissions between 2019–20 and 2020–21.

The intended surgical procedure describes the type of surgery for which a patient has been placed on a public hospital elective surgery waiting list. In some instances, the intended procedure may not reflect what was actually performed during the hospitalisation.

Explore the data

In the data visualisations below, you can explore data about admissions from elective surgery waiting lists for 15 intended procedures and ‘other’ procedures for 2021–22 and recent years by:

• state/territory
• Local Hospital Network (LHN) (where data is available)
• Hospital (where data is available).

The 15 intended procedures selected were previously known as indicator procedures, chosen due to their typically high volume of admissions and long wait times.

Highlights

In 2021–22:

• The 15 indicator procedures accounted for 32% of admissions from elective surgery waiting lists.
• Cataract extraction was the most common intended surgical procedure with 58,200 patients admitted, followed by Cystoscopy with 51,700 patients admitted.

Changes over time

Admissions for most indicator procedures decreased between 2021–22 compared with 2020–21, likely due to the ongoing COVID-19 pandemic.

• Between 2020–21 and 2021–22 and between 2017–18 and 2021–22, admissions from elective surgery waiting lists decreased for all indicator procedures.
• The three procedures with the greatest decrease in admissions were Tonsillectomy (which decreased by 35%), Varicose veins treatment (34%) and Total knee replacement (33%) between 2020–21 and 2021–22. Over the long-term, between 2017–18 and 2021–22, the greatest decreases in admissions were for Varicose veins treatment (which decreased by 15%), Myringotomy (15%) and Tonsillectomy (14%).