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.

In response to the ongoing COVID-19 pandemic in 2020–21, limits on elective surgery continued in some jurisdictions. These restrictions have had effects on the volume, type and timing of elective surgery procedures undertaken in the 2020–21 reporting year.

This section presents analyses on public hospital admissions from elective surgery waiting lists over the 2019–20 and 2020–21 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 and 2020–21 periods by:

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

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.

There was a 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 9.3%
• 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.

During the peak of the COVID‑19 restrictions in 2019–20, the number of public hospital elective surgeries performed ranged from 15,345 in the week commencing 16 March to 4,771 in the week beginning 13 April 2020.

In 2020–21, following the drop in admissions from elective surgery waiting lists in 2019–20, admissions increased 10.7%. This increase was not consistent across all jurisdictions.

Many jurisdictions saw the volume admissions in 2020–21 exceed that of 2019–20 with most, but not all, jurisdictions’ admissions exceeding pre-COVID volumes.

Comparatively larger increases were observed in the New South Wales, Queensland, Western Australia, Tasmania and the Australian Capital Territory.

The greatest increase occurred in Category 3 admissions. This increase may be related to elective surgery COVID-19 recovery projects initiated in a number of jurisdictions in 2020­–21 with the aim of reducing the number of overdue patients by providing an additional number of surgeries.

In Victoria, admissions continued to decrease between 2019–20 and 2020–21. This reflects oongoing limits in place in response to the COVID-19 pandemic which impacted the volume, type and timing of elective surgery procedures undertaken. Admissions in the Northern Territory remained relatively stable.

Urgency of procedure

Compared to 2019–20, in 2020–21:

• people admitted for Category 1 procedures increased by 8.4%
• people admitted for Category 2 procedures increased by 5.6%
• people admitted for Category 3 procedures increased by 15.9%.

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 national restrictions eased on elective surgeries in March 2020, the number of procedures performed began to increase. In the week commencing 9 December 2020, 16,896 procedures were performed, including 5,212 Category 3 procedures. Surpassing number of surgeries performed in the week commencing 9 December 2019 (16,684).

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%).

In 2020–21, most surgical specialties saw an increase in admissions with the exception of Cardiothoracic surgery (4.4% decrease). The surgical specialties with the greatest increase in admissions were:

• Opthalmology surgery (17.8%)
• Paediatric surgery (16.8%)
• Orthopaedic surgery (15.4%).

Type of procedure

With the exception of Coronary artery bypass graft surgery (11% decrease) and Myringotomy (15% decrease), the decrease in admissions seen between 2018–19 and 2019–20, for the most part, reversed between 2019–20 and 2020–21. The intended procedures with the greatest increase in admissions were:

• Septoplasty (34%)
• Total knee replacement (27%)
• Myringoplasty (25%).

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 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

The data visualisation below presents information on additions, removals and admissions in 2020–21 and changes over recent years.

The data can also be explored by:

• overall national trends
• state and territory
• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In  2020–21, admissions from elective surgery waiting lists increased overall by 9.6%. This followed a 9.2% reduction in admissions in 2019–20 due to national restrictions placed on elective surgery associated with the outbreak of COVID-19. This is in contrast with preceding years when admissions from elective surgery waiting lists had been increasing—for example, between 2014–15 and 2018–19, admissions increased, on average, by 2.1% per year.

The change in elective surgery admissions in 2020–21, however, was not uniform across the country—changes ranged from a 21% increase in NSW to a 5.8% decrease in Victoria associated with prolonged restrictions. 

Overall in 2020–21:

• There were 754,600 admissions from public hospital elective surgery waiting lists—99% of which were elective admissions for the awaited procedure. The remaining 1% were admitted as emergency patients because the patient’s condition deteriorated or for other reasons.
• Principal referral and women’s and children’s hospitals and Public acute group A hospitals accounted for three‑quarters of all admissions from elective surgery waiting lists (41% and 35%, respectively).
• 4.1% of admissions from public hospital elective surgery waiting lists were reported for people of Aboriginal and Torres Strait Islander origin who represent 3.3% of the Australian population.

Additions

In 2020–21, 893,163 patients were added to elective surgery waiting lists in Australia—a 6.6% increase over the number of patients added in 2019–20. However, it should be noted that:

• The number of patients added in 2019–20 (837,839) was a 7.1% reduction in the number of additions in the previous year and was affected by restrictions placed on elective surgery and healthcare services more generally.
• In the 5 years to 2018–19, the number of additions to elective surgery waiting lists increased, on average by 2.5% each year.

Removals

In 2020–21:

• 906,525 patients were removed from public hospital elective surgery waiting lists, which was an increase of 11% since 2019–20.
• Most patients (83%) removed from waiting lists were admitted for their awaited 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 11% increase in removals in 2020–21 followed an 8.0% decrease in the number of removals between 2018–19 and 2019–20 due to restrictions on elective surgery due to COVID-19. In prior years (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.

Between 2018–19 and 2019–20 there was a 20% increase in patients removed from elective surgery waiting lists due to being transferred to another hospital’s waiting list. This number increased again by 40% between 2019–20 and 2020–21 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 performing the elective surgery. This section presents information on the type of elective surgery provided, by surgical speciality, in 2020–21 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. From 1 July 2016, surgical speciality was revised to include Paediatric surgery.

The data visualisation below presents information on admissions from elective surgery waiting list by state and territory in 2020–21 and for recent years.

The data can also be explored by:

• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In 2020–21:

• 20% of patients were admitted for General surgery (on abdominal organs, including endocrine surgery and breast surgery). This was the most common surgical specialty following admission from a waiting list.
• 15% were admitted for Urological surgery (on organs of the urinary system such as bladder, urethra and kidneys) and 14% were admitted for Orthopaedic surgery (on bones, joints, ligaments and tendons, including knee and hip replacements).

Changes over time

Between 2018–19 and 2019–20 there was an overall decrease in admissions for elective surgery across all surgical specialities due to restrictions on elective surgery implemented due to COVID-19 pandemic.

In 2020–21, as restrictions eased in most jurisdictions, there was an increase in admissions for elective surgery across all surgical specialties with the exception of Cardiothoracic surgery. 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 continuation of restrictions on elective surgery admissions across some jurisdictions in 2020–21 due to the COVID-19 pandemic should be taken into account when interpreting this data.

Between 2019–20 and 2020–21:

• admissions from elective surgery waiting lists increased for 10 of the 11 surgical specialities
• Paediatric surgery and Ophthalmology surgery had the largest increase in admissions, 17% and 18% respectively
• Cardiothoracic surgery decreased 4.4%.

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 indicator procedures and ‘other’ procedures for 2020–21 and other recent years by:

• Overall national trends and state/territory
• Local Hospital Network (LHN) (where data is available)
• hospital (where data is available).

Highlights

In 2020–21:

• the 15 indicator procedures accounted for 35% of admissions
• Cataract extraction was the most commonly reported intended surgical procedure with 73,100 patients admitted, followed by Cystoscopy with 67,500 patients admitted.

Changes over time

Following decreases in admissions for most procedures between 2018–19 and 2019–20, admissions for most indicator procedures increased in 2020–21.

Between 2019–20 and 2020–21:

• admissions from elective surgery waiting lists increased for most indicator procedures with the exception of Myringotomy (which decreased 15%) and Coronary artery bypass surgery (which decreased 12%)
• the two procedures with the greatest increase in admissions were Septoplasty (which increased 32%) and Total knee replacement (27% increase).