Here you will find analyses of geographical variation in the use of healthcare services withing day surgery in Norway. The analyses include, among other things, updates of selected chapters from the Day Surgery Atlases (1 and 2). You will also find analyses of the use of other procedures where a significant portion of the activity is performed as day surgery.
Number of tonsil operations per 1 000 child, 0-15 år
Approximately 5 000 tonsil operations are performed annually on children under 16 years old. The number of operations dropped significantly during the pandemic and only returned to pre-COVID-19 levels in 2023. There is significant geographical variation in the number of operations. Boys are operated on more frequently than girls, and the average age at the time of surgery is slightly lower for boys than for girls.
The proportion of partial tonsil removals (tonsillotomies) has increased from just under 10 % in 2015 to over 40 % after the pandemic. According to the Tonsil Register, one reason for this is that the indication for hypertrophy is used more often for children, and tonsillotomy is considered a safer procedure with fewer postoperative complications.
Children are mainly treated in their own health trust. The significant observed geographical variation over time may indicate overtreatment in some areas and undertreatment in others. However, data from the Tonsil Register for 2023 shows that 92 % were symptom-free 6 months after surgery. The reduction in the rate for the Bergen catchment area from 2022 to 2023 is likely due to a lack of reporting from contracted specialists in 2023.
Number of tonsil operations per 1 000 inhabitants, 16 years and older
Approximately 5 000 tonsil operations are performed annually on patients aged 16 and older. The number of operations per year was increasing in the period before the pandemic, peaking in 2019 with nearly 6 000 operations. In 2023, 5 000 operations were performed.
There is significant geographical variation in operation rates, with the areas with the highest rates performing about twice as many tonsil operations per 1 000 inhabitants compared to the areas with the lowest rates.
Women are operated on more frequently than men, and the average age at the time of surgery is about two years lower for women (26 years in 2023) than for men (28 years in 2023). The average age has decreased over the period for both men and women. The reduction in the rate for the Bergen catchment area from 2022 to 2023 is likely due to a lack of reporting from contracted specialists in 2023.
Number of surgeries for Hallux valgus and Hammertoe per 1,000 inhabitants
The number of surgeries has decreased throughout the period, from 5,400 in 2015 to 3,100 in 2023. Women accounted for approximately 80 % of the surgeries in 2023, and the decline in the number of surgeries during the period is mainly due to fewer surgeries on women.
There is significant geographical variation in surgery rates. The catchment areas with the highest rates perform about three times as many surgeries per 1,000 inhabitants compared to the catchment areas with the fewest surgeries, classifying the variation as unwarranted. The catchment areas for Stavanger and Bergen HF have consistently low rates, while the catchment areas for Finnmark and UNN HF have consistently high rates.
More than half of the surgeries are performed in their own health trusts, and about 20 % are performed privately for the country as a whole, but there are significant differences between catchment areas. In 2023, about half of the surgeries were performed privately in the catchment areas for Finnmark and St. Olav HF, while no surgeries were performed privately in the catchment areas for Vestre Viken and Telemark HF.
Number of procedures with ventilation tubes in the eardrum per 1,000 children, 0-16 years
Approximately 5,000 procedures involving the insertion of ventilation tubes in the eardrum are performed annually on children aged 0-16 years. The number of procedures decreased from 2015 to 2019, and there was a significant drop during the pandemic. In 2023, the number of procedures returned to the 2019 level.
There is significant geographical variation in the number of procedures. The catchment area for Nord-Trøndelag HF consistently has the highest rate throughout the period, while the catchment areas in Oslo (OUS, Lovisenberg, and Diakonhjemmet HF) consistently have low rates. The procedure is performed more than three times as frequently on children in the catchment area for Nord-Trøndelag HF compared to the Oslo area in all years of the period. This suggests that there is a lack of consensus among medical experts regarding the appropriate indications for using ventilation tubes. The medical need is assumed to be approximately the same regardless of where in Norway one lives, and the variation therefore is considered as unwarranted.
The procedure is performed more frequently on boys than girls, with 60 % of the procedures performed on boys. The average age at the time of the procedure was five years, and the procedure is most commonly performed on three-year-olds.
Children are mainly treated in their own HF, but there are significant differences between catchment areas. In 2023, 75 % of the procedures were performed in their own HF, 8 % in another HF, and 16 % were performed privately for the country as a whole. In the catchment areas for St. Olav and Diakonhjemmet HF, more than half of the procedures in 2023 were performed privately.
Number of procedures per 1 000 women
During the period 2015-2019, the number of procedures remained stable at just over 4,000 per year. In 2020, the number of procedures decreased by approximately 20% compared to the period 2015-2019. After the pandemic, the annual number of procedures has increased each year, and in 2023, around 3,700 procedures were performed. The median age was 64 years in 2023 and 63 years for the perioden 2015-2022.
The geographical variation has been significant throughout the period from 2015 to 2023. The variation has been somewhat greater in the period after the pandemic (2021-2023) than in the period before the pandemic (2015-2019). The catchment areas of OUS, Diakonhjemmet, Lovisenberg, Akershus, and Vestfold have had low rates throughout the period from 2015 to 2023. The catchment area of Finnmark has had the highest rate throughout the period 2015-2023, except for the pandemic year 2020. Helgeland, Fonna, and Nord-Trøndelag have also had high rates throughout the period 2015-2023.
The extent of treatment in private facilities is very limited.
Nationally, the proportion of procedures performed as day surgery increased from 24% in 2015 to 40.5% in 2023. There is significant variation between the catchment areas. In the catchment areas of Finnmark, OUS, Sørlandet, and Lovisenberg, less than 10% of operations were performed as day surgery in 2023, while in the catchment area of St. Olav, the corresponding proportion was 84%.
Number of surgeries for carpal tunnel syndrome per 1,000 inhabitants
An average of approximately 7,400 operations for carpal tunnel syndrome are performed annually. The annual number of operations was minimally affected by the pandemic. There was a slight decrease for women in 2020, and 2021 was a peak year for both sexes compared to the other years in the period 2015–2023.
There is significant geographic variation in operation rates. In the catchment areas with the highest rates, approximately three times as many operations per 1,000 inhabitants are performed compared to the areas with the lowest rates. In 2023, the number of operations per 1,000 inhabitants ranged from 0.9 in Lovisenberg to 2.7 in Nordland.
The Oslo area (OUS, Lovisenberg, and Diakonhjemmet HF) consistently has the lowest rates throughout the period. Innlandet and Østfold HF have had the highest rates during the period. The low rate in Østfold HF in 2023 is likely due to incomplete reporting from private specialists. In the catchment areas of UNN and Førde HF, rates have risen sharply over the past three years.
Women undergo surgery more often than men, and the proportion of surgeries performed on women was 61 % in 2023.
