Elective surgery activity

Since early 2020, restrictions on performing 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 because 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 2022–23 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 2022–23 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 9.2% reduction in admissions from public hospital elective surgery waiting lists associated with the introduction of COVID‑19 restrictions that applied nationally. 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 2020 to 26,500 in April 2020.

In 2020–21, admissions from elective surgery waiting lists 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%. During the peak of COVID‑19 infections in 2021–22, the number of public hospital elective surgeries performed per month decreased from 46,700 in December 2021 to 26,200 in January 2022.

In 2022–23, following the decrease in admissions from public hospitals elective surgery waiting lists in the previous year, admissions increased by 18% from 623,000 to 735,500. This increase was seen across most states and territories.

Urgency of procedure

Monthly admissions from public hospital elective surgery waiting lists for Category 3 (i.e. lowest emergency) procedures are usually between 15,000 and 25,000. Since 2018–19, this number fell under 10,000 in April 2020 and May 2020, and January 2022 and February 2022. These considerable declines in Category 3 procedures are most likely due to disruptions to the delivery of hospital services because of rising COVID–19 cases.

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 2022–23 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

In 2022–23:

• there were 735,500 admissions from public hospital elective surgery waiting lists – 99% of which were elective admissions for the intended procedure and 1% of which were emergency admissions because the patient’s condition deteriorated or for other reasons
• ofthe 735,500 admissions, 239,800 (33%) were Category 1, 278,600 (38%) were Category 2, and 217,100 (30%) 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)
• 4.4% of admissions from public hospital elective surgery waiting lists were for First Nations people, who represent 3.8% of the Australian population.

In 2022–23, admissions from elective surgery waiting lists increased by 18% compared with 2021–22, likely due to the easing of COVID-19 restrictions and limitations on hospital services during the previous period. In comparison, in the last three years, there was a 17% decrease in admissions in 2021–22, a 9.6% increase in 2020–21 and a 9.2% decrease in 2019–20. 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 2021–22 to 2022–23, was not uniform across Australia. In the ACT, admissions decreased by 9.9%, while admissions increased in Victoria by 29%.

Additions to elective surgery waiting lists

In 2022–23, 855,500 patients were added to elective surgery waiting lists in Australia – a 9.2% increase from the number of patients added in 2021–22. However, it should be noted that:

• the number of patients added in 2018–19, which was prior to the outbreak of COVID-19, was 893,000
• 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 2022–23:

• 888,400 patients were removed from public hospital elective surgery waiting lists – an increase of 17% compared with 2021–22
• most patients removed from waiting lists (83%) 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 17% increase in removals in 2022–23 followed a 16% decrease in 2021–22, a 11% increase in 2020–21 and 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. 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.

Between 2021–22 and 2022–23, there was an 18% decrease in patient removals due to being transferred to another hospital’s waiting list; and in the year prior, it decreased by 12%. In comparison, between 2019–20 and 2020–21 there 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 2022–23 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.

Explore the data

This data visualisation below presents data for 2022–23 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 overall impact of the COVID–19 pandemic in recent years should be considered when interpreting this data.

Highlights

In 2022–23, of the 735,500 admissions from elective surgery waiting lists:

• 20% were for General surgery (on abdominal organs, including endocrine surgery and breast surgery), which was the most common surgical specialty resulting in an admission from a waiting list
• 15% were for Urological surgery (on organs of the urinary system such as bladder, urethra, and kidneys) and 14% were for Ophthalmology surgery (on eyes and optic nerves).

Changes over time

• Between 2021–22 and 2022–23, overall admissions from elective surgery waiting lists increased by 18%, whereas between 2018–19 and 2022–23, it decreased annually by 0.8%.
• Between 2021–22 and 2022–23, Otolaryngology, head, and neck surgery and Ophthalmology surgery had the largest increase in admissions 27% and 25% respectively. This was not consistent with changes between 2018–19 and 2022–23; in that period, Otolaryngology, head, and neck surgery decreased annually by 1.9%, while Ophthalmology surgery slightly increased annually by 0.5%.
• Between 2021–22 and 2022–23, Vascular surgery and Urological surgery had the smallest increase in admissions by 10.7% and 11.1% respectively, while between 2018–19 and 2022–23, these both decreased annually by 1.4% and 0.4% respectively. 

In general, admissions from elective surgery waiting lists decreased in 2019–20, increased in 2020–21, decreased in 2021–22 and then increased again in 2021–22. This pattern was evident across all surgical specialties, except for cardiothoracic surgery which had decreased in 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 selected intended procedures and ‘other’ procedures for 2022–23 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 2022–23:

• the 15 selected intended procedures accounted for 34% of admissions from elective surgery waiting lists
• Cataract extraction was the most common selected intended surgical procedure with 75,500 patients admitted, followed by Cystoscopy with 55,200 patients admitted. 

Changes over time

Admissions for all selected intended procedures increased between 2022–23 compared with 2021–22, likely due to the easing of elective surgery restrictions, bringing the delivery of health care services closer towards pre-pandemic levels. 

The three procedures with the greatest increase in admissions between 2022–22 and 2022–23 were: Septoplasty (which increased by 47%), Total knee replacement (42%) and Haemorrhoidectomy (41%). However, over the long-term, between 2018–19 and 2022–23, admissions for most indicator procedures decreased. The greatest decreases in annual admissions were for Varicose veins treatment (which decreased on average by 9.0%), Myringotomy (8.1%) and Tonsillectomy (6.2%).