Surgical procedures

Age group — in the statistics of surgical procedures, data is collected on persons aged 0–14 and persons aged 15 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 and lists). 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 provider 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 in-patient health care service, or hospital care.

• Outpatient health care service, or outpatient care — outpatient health care service, when a patient’s visit to a health care institution is confined to a few hours and overnight stay in an in-patient facility is not needed.

  Outpatient surgery — a surgical procedure which is performed to an outpatient.

• Day care — outpatient health care service which requires the patient to stay in a hospital bed under medical supervision for a period of several hours due to treatment or examination. In the evening/at night the patient goes home.

  Day surgery — carrying out a surgical procedure which is performed to a day care patient.

• In-patient health care service, or hospital care — health care service, in case of which a patient needs to stay in hospital for 24 hours.

  In-patient surgery — carrying out a surgical procedure to an in-patient.

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 and lists).

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 in-patient surgical service providers.

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

• Annual report “Hospital“ tables „Surgical work“ and “Emergency surgery“
• Annual report “Day Care“ tables „Surgical work“ and “Emergency surgery“
• Annual report “Health Care facility“ table “Outpatient surgical procedures“

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 in-patient 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

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 Estonian) in the Classifications section.

List 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.

List 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:

• Hospital — a health care provider which complies with the requirements related to location, construction, administrative organisation and staff, aimed at providing in-patient medical care in medical specialties. As a rule, in addition to in-patient health care service, hospitals also provide outpatient and day care services.
• Family doctor’s office — a health care provider in which outpatient health care services are provided by a medical practitioner specialised as a family doctor operating based on his/her practice list.
• Specialist health care provider — a health care provider in which outpatient health care services are provided by a medical specialist and health care professionals working with him/her. These include the facilities providing occupational health services.
• Dental care provider — a health care provider in which outpatient health care services are provided by a dentist and health care professionals working with him/her.
• Emergency medical care provider — outpatient health care provider for the initial diagnosis and treatment of a life-threatening disease, injury or poisoning and, if necessary, for the transport of the person in need of assistance to a hospital. Emergency medical care providers only encompass independent emergency medical care providers.
• Rehabilitation care provider — a health care provider which provides outpatient health care services with the aim of improving people’s condition of health and in case of which the health-related limits to everyday life either arise from an injury or the chronic nature of the disease.
• Diagnostics provider — a provider of outpatient health services for the assessment of the patient’s state of health with the help of laboratory tests and diagnostic examinations.
• Nursing care provider — a health care provider in which independent outpatient or in-patient health care services are provided only by nurses and/or midwives.
• Other provider — this group includes providers which have not been mentioned above, but which hold an activity licence enabling them to provide health care services, e.g., Estonian Defence Forces, facilities providing school health care service, prison outpatient medical departments and also the providers which deal with the organisation of first aid courses, hold telephone medical consultations and provide support staff for family physicians.

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.

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

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

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

Merike Rätsep

Department of Health Statistics

National Institute for Health Development

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

Updated: 13.10.2022