All ESP data represent surgical procedures performed in public, private and university hospitals (>90% of all procedures).  For each country, data were derived from national databases and interviews with private hospitals and professional organizations.  The data were standardized using the ICD-9 system for comparison and then validated via interviews with 25 physician experts and opinion leaders in each specialty (ENT, Cardiology, Orthopedics, etc.) per country.  The following outlines the specific methodology for the most recent version of ESP. Specific data sources for each country are available upon request.

PROCEDURES INCLUDED

General

The European Surgical Procedures Database (ESP) includes both primary and secondary surgical procedures performed in the public, private and university hospitals in France, the United Kingdom (UK), Germany, Spain and Italy. For each country, data were derived from national databases and interviews with private hospitals and professional organizations.  The data were standardized using the ICD-9 system for comparison and validated via interviews with 25 physician experts and opinion leaders in each specialty (ENT, Cardiology, Orthopedics, etc.) per country. A complete list of definition sources is given below.

Most recently available data:

Data are derived from the most recently available data in each country. The 2007 ESP Release reflects 2005 and 2006 data from France, Germany, Italy, the United Kingdom and Spain.

METHODOLOGY

To make sure we handle the same definitions in each European country, procedures are defined by identifying the correct ICD-9 code. The definition of this code is then used to find in each country the country-specific codes.

Data-identification:

When there is a clear code translation from the ICD-9 coding to the country-coding, the numbers are identified in the country-databases.

Some ICD-9 procedures are in other coding systems part of more general code. To filter out the defined procedure, we contact national organisations and/or opinion leaders and/or experts.

When no country-specific codes are identified, TforG has conducted expert interviews to gather the data.

Validation:

To validate the data, the following quality checks are taken into account:

1)  All data are double-checked and verified with national organizations.

2)  The procedures/population ratio is calculated for each country for comparison.

3)  The growth path for each procedure is compared to the prior year.

4)  When data-points deviate more than 10% from the prior year or when the procedures/population ratio from one country is completely different from the others, the database figures are checked with national organizations and/or opinion leaders.

Change in process:

As the different country-databases in Europe also evolve, there can be a change in data identification from one year to the next for a specific procedure.
This can mean a new database is launched and/or new and more detailed codes are added.
For procedures where the data-identification is handled differently compared to last year, the numbers are put in bold and italic. This also means that for these data-points some caution needs to be taken into account when comparing current figures with last year's figures.
In France the coding system changed in 2005-2006. Before 2005 hospitals were working with the Cdam coding (Catalogue des Actes Médicaux). 2005 was the transition year where hospitals started coding their procedures according to the CCAM (Classification Commune des Actes Médicaux). In 2006 all hospitals coded their procedures according the CCAM system. The CCAM coding system is a lot more detailed compared to the Cdam system. Because of this some caution needs to be taken into account when comparing the French procedures with last year's figures.

 Forecast Model:

The forecasted procedure volumes were measured by means of a forecast model based on the following variables:
1) Expert's forecasted growth rate, based on expected changes in the reimbursement system, new surgical techniques, expected incidence rate evolution, etc.
2) Last 2 year's procedure volume growth rate.
3) The population growth rate.
In order to measure the Expert's forecasted growth rate, 10 experts per medical field were interviewed.

DEFINITION SOURCES

Expert Interviews

20-25 interviews per medical field
(ENT, Cardiology, Orthopaedics, etc. Departments) per country. 
TforG contacted the head doctors to give an overview on the number of surgical procedures (per type) performed per year in their department.

National Organisations and Opinion Leaders

National organisations: medical or governmental
(e.g. National Cardiology Association or The Society of Cardio-Thoracic Surgeons). 
Opinion leaders: those active in university clinics or national/European medical associations.