NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Chapter 5 | SURGICAL SERVICES IN MALAYSIAN HOSPITALS Harjit S1, Gunn AKB2, Abdul JA3, Mohamed YAB4, Tahrani PK5*, Faizah A5* Jiffre D6, Nik ANA7, Clement ET8, Tan WJ9, Nik MSNY10, Jasiah Z11, Chuah JA12, Azali HY13, Khairun NM14, Patimah A15.

1. Hospital Selayang 2. Hospital Sultanah Aminah, Johor Bahru 3. Hospital Sultanah Zahirah, Kuala Terengganu 4. Hospital Tengku Ampuan Rahimah, Klang 5. Clinical Research Centre, Ministry of Health 6. Hospital Tengku Ampuan Afzan, Kuantan 7. Sarawak General Hospital 8. Hospital Tuanku Fauziah, Kangar 9. Hospital Pulau Pinang 10. Hospital Raja Perempuan Zainab II, Kota Bharu 11. Hospital Tuanku Jaafar, Seremban 12. Hospital Queen Elizabeth, Kota Kinabalu 13. Hospital Melaka 14. Hospital Sultanah Bahiyah, Alor Setar 15. Medical Development Division, Ministry of Health. * Corresponding author.

Summary: The distribution of general surgery services in Malaysia was inequitable and uneven. There were 167 hospitals with general surgical services in 2010. The general surgeon to population ratio in Malaysia for 2010 was 0.06 per 10,000 population, far below that of developed countries. The distribution of the general surgeons was fairly uniform between the public and private sector. The urbanised west coast states of Peninsular Malaysia had the highest concentration of surgical services provided by private hospitals. However, in the distribution of surgical services, public hospitals were somewhat more uniform throughout the country. The nature of surgical procedures undertaken showed a significant variation, with public hospitals performing the highest numbers of emergency surgeries (for example, appendicectomies and trauma-related laparotomies) and private hospitals mainly performing elective surgeries (for example, cholecystectomies and thyroidectomies). In terms of surgical approach, surgeons at private hospitals performed more laparoscopic cholecystectomies and laparoscopic appendicectomies when compared to surgeons working at public hospitals.

Overview

Surgery is an essential component of basic health care and is currently considered an integral part of primary health care. It provides an effective way of dealing with various clinical conditions such as injuries, acute infections, tumours and malignancies, various congenital defects and deformities.

General surgical services in this survey includes the specialty of general surgery and its various subspecialties of breast and endocrine, upper gastrointestinal, colorectal, vascular, hepatobiliary, trauma and cardiothoracic surgeries. This survey was undertaken in all Ministry of Health, university and private hospitals in Malaysia, with general surgical services being provided by resident or visiting general surgeons. In addition, hospitals with visiting surgeons were only included if elective surgery was performed in their establishments.

Facilities

One hundred and sixty seven hospitals providing general surgical services in Malaysia; 60 from the public sector, including 3 university hospitals, and 107 from the private sector. The response rate to this survey was 100% from public hospitals and 66 % from private hospitals.

This study revealed that on average 0.06 hospitals per 10,000 population provided general surgical services. The surgical services were most concentrated in Wilayah Persekutuan Kuala Lumpur (WPKL) (0.13 per 10,000 population), followed by Pulau Pinang (0.10 per 10,000 population), Negeri Sembilan (0.08 per 10,000 population) and Perak (0.06 per 10,000 population) respectively. These states also had the highest concentration of private hospitals providing surgical services. The ratio of surgical services in the other states ranged from 0.03 to 0.06 hospitals per 10,000 population with Sabah having the lowest concentration of surgical services (0.03 per 10,000 population) (Table 5.1).

There were a total of 901 operating rooms in Malaysia, 529 (59%) in public hospitals and 372 (41%) in private hospitals. The overall distribution of operating rooms in Malaysia was 0.32 per 10,000 population with widely disparate distribution of operating rooms between Pulau Pinang, WPKL, Melaka, Selangor and Putrajaya compared to Sabah, Sarawak and Perlis. This disparity was partly due to the operation rooms contributed by the higher concentration of private hospitals in the urbanised west coast states of Peninsular Malaysia.

This survey also revealed that at least 15% of the operation rooms in the country were non functional. This was probably due to the lack of human resources and/or infrastructural defects and deficiencies.

Most of the public hospitals had at least one dedicated trauma/emergency operation theatre. However, there was an overall lack of dedicated surgical high dependency beds in most hospitals in the country (Table 5.2). Surgical Services in Malaysian Hospitals 5 59 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Activities

Elective Operating Hours

The elective operating hours were better defined in the public hospitals as opposed to the private hospital where there was no distinct separation of elective and emergency operating hours. Thus, reporting of elective operating hours was strictly confined to the public hospitals.

The average elective operating hours was 4.78 hours per surgeon per week. There was significant variation (ranging from 2.21 to 13.60 hours per surgeon per week) in the number of elective operating hours throughout the country. This variation was due principally to the differing numbers of surgeons (including subspecialty trainees) sharing the available operating time and also hinges on the availability of anaesthesiologists. Hospitals with higher numbers of trainees had a correspondingly lower ratio of operating hours per surgeon. In some states, both local anaesthesia (LA) and general anaesthesia (GA) cases were being reported, thus, giving higher ratios of elective operating hours. To overcome such reporting disparity, future data collection should strictly define this variable as elective operating hours under general or regional anaesthesia and should exclude elective operating hours under local anaesthesia (Table 5.3).

General Surgery Operations

The data on some common general surgical procedures performed in the country were also collected in order to assess the distribution of general surgery workload. In 2010, a total of 33,935 appendicectomy operations were performed in the country, 18,536 (54.6%) in public and 15,399 (45.4%) in private. Twenty percent of these appendicectomies were performed laparoscopically; a majority of which were done in the private hospitals.

The low numbers of such operations performed in Sabah and Sarawak may not be truly reflective of the situation as data was only collected from those hospitals that had resident or visiting surgeons while it excluded data from non specialist public hospitals where most of the emergency and minor elective surgeries were undertaken by medical officers (Table 5.4).

In 2010, a total of 2,343 laparotomies were performed for trauma. A majority of these operations were performed in public hospitals (1,631 in public and 712 in private hospitals) (Table 5.5).

A total of 3,566 mastectomies were reported in 2010 and a majority of these were performed in the three tertiary breast centres; Hospital Putrajaya (n=130), Hospital Kuala Lumpur (n=296) and University Malaya Medical Centre (n=195) (Table 5.5). An average of 1 mastectomy performed per 10,000 population in Malaysia was low when compared to the European Community Health Indicators (ECHI) data that reported 5 mastectomies per 10,000 population1. This gap may be due to the differences in incidence rates of breast cancer in Europe and Malaysia.

A total of 14,120 inguinal hernia operations were reported in 2010. These were almost equally distributed in the public and private hospitals (Table 5.6). Only 1,215 (8.6%) of the inguinal hernia repairs were performed laparoscopically, giving a ratio of 5 cases per 10,000 population, which was much less than in European countries that reported 23 cases per 10,000 populations1.

A total of 9,909 cholecystectomies were performed in 2010, 2,924 in public and 6,985 in private, of which 7,601 (76.7%) were performed laparoscopically in the private hospitals (Table 5.7). ECHI data reveal almost 10 times more cholecystectomies being performed laparoscopically, giving an average ratio of 26 cases per 10,000 population1, compared to Malaysia where only 3 cases per 10,000 population were undertaken laparoscopically.

In 2010, a total of 5,114 thyrodectomies were reported in Malaysia, of which 1,882 (36.8%) were performed in public hospitals and 3,232 (63.2%) were performed in private hospitals

Based on this survey, it is apparent that the majority of emergency surgeries (appendicectomies and trauma related laparatomies) were performed in the public healthcare system while most elective surgical procedures (cholecystectomies and thyroidectomies) were performed in the private hospitals.

There were a total of 1,969 cases of post operative mortality reported in this survey. The majority (88%) of it occurred following emergency surgeries. The post operative mortality rate for elective surgery in 2010 was 0.08 per 10,000 population (Table 5.8).

General Surgery Workforce

For the year 2010, there were 539 general surgeons in the country. Of these, 302 (56%) served in the public and 237 (44%) in the private hospitals (Table 5.9).

The general surgeon to population ratio in Malaysia was 0.19 per 10,000 population. This figure is low when compared to other developed countries. In the United Kingdom (UK), there were 1.1 general surgeons per 10,000 population2. In addition, there was very significant disparity in the distribution of general surgeons in the various states of Malaysia with a definite higher distribution in WPKL, Selangor/WP Putrajaya and Pulau Pinang than in Terengganu, Sabah and Sarawak.

60 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

There were a total of 3,668 scrub nurses attached to the operation theatres in Malaysia, giving a ratio of 5.09 nurses per functioning operation theatre. The ratio was slightly lower in the private hospitals compared to public hospitals (Table 5.9).

Currently, training of general surgeon specialists and subspecialists is almost exclusively undertaken in the public healthcare system and in the universities. There is a huge potential for training of general surgeons in the private healthcare system in Malaysia, as suggested by Aitken (2012)3. However, this has significant cost implications and needs to be explored further. This report shows that the distribution of subspecialist general surgeons in the country was fairly limited and unequal.

Limitations

1. The data on dedicated emergency or trauma operating rooms does not reflect the total number of such operation rooms available in Malaysia. It only indicates the number of such dedicated emergency or trauma operating rooms available in the public healthcare system. Most private hospitals do not dedicate a special operating room for such purposes in view of the cost implications.

2. Similarly, most private and some public hospitals also do not have dedicated surgical high dependency beds as these are generally under the purview of the intensive care units or anaesthesiology departments.

3. This survey does not reflect the total workload of surgeons as it only captures certain selected types of surgeries performed.

4. Elective operating hours data as captured in this report, do not quantify the actual number of operating hours per surgeon in the country as the data provided also included a significant number of surgeries done under local anaesthesia (LA). To overcome such reporting disparity, future data collection should strictly define this variable as elective operating hours under general or regional anaesthesia, and should exclude elective operating hours under local anaesthesia.

References

1. European Commision, Public Health. European Community Health Indicators (ECHI), Selected Surgery. 2010. [Updated 3 January 2012; Cited on 4 April 2012]. Available from: http://ec.europa.eu/health/indicators/echi/

2. Health and Social Care Information Centre, Workforce and Facilities Team. Medical and dental workforce staff in England 2001-2011. NHS Workforce Census, 2001-20011. UK. 2011 March. Available from: http://www.ic.nhs.uk/webfiles/publications/010_Workforce/

3. Aitken, R. J. Lost opportunity cost of surgical training in the Australian private sector. ANZ Journal of Surgery, 2010; 82: 145–150. Surgical Services in Malaysian Hospitals 5 61 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.1 Number and Density of Hospitals Providing General Surgical Services in Malaysia by State and Sector, 2010 Year 2010 State Sector No. Per 10,000 population Malaysia Public 60 - Malaysia Private 107 - Malaysia Total 167 0.06 Perlis Public 1 - Perlis Private 0 na Perlis Total 1 0.04 Kedah Public 4 - Kedah Private 4 - Kedah Total 8 0.04 Kedah & Perlis Public 5 - Kedah & Perlis Private 4 - Kedah & Perlis Total 9 0.04 Pulau Pinang Public 4 - Pulau Pinang Private 11 - Pulau Pinang Total 15 0.10 Perak Public 5 - Perak Private 10 - Perak Total 15 0.06 Selangor & WP Putrajaya Public 7 - Selangor & WP Putrajaya Private 25 - Selangor & WP Putrajaya Total 32 0.06 WP Kuala Lumpur Public 3 - WP Kuala Lumpur Private 19 - WP Kuala Lumpur Total 22 0.13 Selangor & WP Putrajaya & WP KL Public 10 - Selangor & WP Putrajaya & WP KL Private 44 - Selangor & WP Putrajaya & WP KL Total 54 0.07 Negeri Sembilan Public 2 - Negeri Sembilan Private 6 - Negeri Sembilan Total 8 0.08 Melaka Public 1 - Melaka Private 3 - Melaka Total 4 0.05 Johor Public 7 - Johor Private 12 - Johor Total 19 0.06 Pahang Public 2 - Pahang Private 3 - Pahang Total 5 0.03 Terengganu Public 3 - Terengganu Private 1 - Terengganu Total 4 0.04 Kelantan Public 6 - Kelantan Private 2 - Kelantan Total 8 0.05 Sabah & WP Labuan Public 8 - Sabah & WP Labuan Private 3 - Sabah & WP Labuan Total 11 0.03 Sarawak Public 7 - Sarawak Private 8 - Sarawak Total 15 0.06 Abbreviation: na – not applicable 62 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.2 Number and Density of Operating Rooms (ORs), Functioning ORs, Dedicated Emergency/Trauma Theatres and Surgical High Dependency Beds in Malaysia by State and Sector, 2010 Dedicated Functioning Surgical High ORs Emergency/ ORs Dependency Beds State Sector Trauma Theatres Per 10,000 Per 10,000 No. No. No. No. population population Malaysia Public 529 - 435 - 55 108 Malaysia Private 372 - 333 - 55 147 Malaysia Total 901 0.32 768 0.27 110 255 Perlis Public 5 - 5 - 1 0 Perlis Private na na na na na na Perlis Total 5 0.22 5 0.22 1 0 Kedah Public 32 - 24 - 6 17 Kedah Private 15 - 12 - 4 7 Kedah Total 47 0.24 36 0.18 10 24 Kedah & Perlis Public 37 - 29 - 7 17 Kedah & Perlis Private 15 - 12 - 4 7 Kedah & Perlis Total 52 0.24 41 0.19 11 24 Pulau Pinang Public 27 - 24 - 2 5 Pulau Pinang Private 43 - 40 - 5 16 Pulau Pinang Total 70 0.45 64 0.41 7 21 Perak Public 35 - 32 - 5 24 Perak Private 31 - 28 - 3 25 Perak Total 66 0.28 60 0.26 8 49 Selangor & WP Putrajaya Public 105 - 67 - 7 15 Selangor & WP Putrajaya Private 86 - 76 - 12 20 Selangor & WP Putrajaya Total 191 0.35 143 0.26 19 35 WP Kuala Lumpur Public 79 - 74 - 4 33 WP Kuala Lumpur Private 73 - 65 - 9 14 WP Kuala Lumpur Total 152 0.91 139 0.83 13 47 Selangor & WP Putrajaya & WPKL Public 184 - 141 - 11 48 Selangor & WP Putrajaya & WPKL Private 159 - 141 - 21 34 Selangor & WP Putrajaya & WPKL Total 343 0.48 282 0.39 32 82 Negeri Sembilan Public 12 - 10 - 1 0 Negeri Sembilan Private 18 - 18 - 6 13 Negeri Sembilan Total 30 0.29 28 0.27 7 13 Melaka Public 11 - 10 - 2 0 Melaka Private 21 - 18 - 3 15 Melaka Total 32 0.39 28 0.34 5 15 Johor Public 44 - 33 - 5 14 Johor Private 40 - 33 - 8 30 Johor Total 84 0.25 66 0.20 13 44 Pahang Public 30 - 25 - 4 0 Pahang Private 9 - 9 - 0 0 Pahang Total 39 0.26 34 0.23 4 0 Terengganu Public 18 - 15 - 2 0 Terengganu Private 2 - 2 - 0 0 Terengganu Total 20 0.19 17 0.16 2 0 Kelantan Public 25 - 24 - 1 0 Kelantan Private 3 - 3 - 1 1 Kelantan Total 28 0.18 27 0.18 2 1 Sabah & WP Labuan Public 48 - 42 - 8 0 Sabah & WP Labuan Private 10 - 8 - 1 0 Sabah & WP Labuan Total 58 0.18 50 0.15 9 0 Sarawak Public 58 - 50 - 7 0 Sarawak Private 21 - 21 - 3 6

Sarawak Total 79 0.32 71 0.29 10 6 Surgical Services in Malaysian Hospitals

Abbreviation: na – not applicable 5 63 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.3 Number and Density of General Surgeons and Total Elective Operating Hours in Public Hospitals in Malaysia by State, 2010 General Surgeons Total Elective Operating Hours /Weeks State No. No. Ratio to General Surgeons Malaysia 302 1,445 4.78 Perlis 2 23 11.50 Kedah 23 104 4.52 Kedah & Perlis 25 127 5.08 Pulau Pinang 14 113 8.07 Perak 15 144 9.60 Selangor & WP Putrajaya 62 228 3.68 WP Kuala Lumpur 56 124 2.21 Selangor & WP Putrajaya & WPKL 118 352 2.98 Negeri Sembilan 10 61 6.10 Melaka 8 47 5.88 Johor 24 117 4.88 Pahang 18 81 4.50 Terengganu 5 68 13.60 Kelantan 26 103 3.96 Sabah & WP Labuan 18 128 7.11 Sarawak 21 104 4.95

64 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.4 Number and Density of Total Appendicectomies in Malaysia by State and Sector, 2010 Total Laparoscopic Open Procedures Appendicectomies Procedures State Sector Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia Public 18,536 - 17,230 - 1,307 - Malaysia Private 15,399 - 9,752 - 5,647 - Malaysia Total 33,935 11.98 26,982 9.52 6,954 2.45 Perlis Public 427 - 423 - 4 - Perlis Private na na na na na na Perlis Total 427 18.44 423 18.27 4 0.17 Kedah Public 1,951 - 1,829 - 122 - Kedah Private 709 - 359 - 350 - Kedah Total 2,660 13.66 2,188 11.23 472 2.42 Kedah & Perlis Public 2,378 - 2,252 - 126 - Kedah & Perlis Private 709 - 359 - 350 - Kedah & Perlis Total 3,087 14.17 2,611 11.98 476 2.18 Pulau Pinang Public 887 - 818 - 69 - Pulau Pinang Private 1,474 - 846 - 627 - Pulau Pinang Total 2,361 15.12 1,664 10.66 696 4.46 Perak Public 1,694 - 1,419 - 275 - Perak Private 2,768 - 1,971 - 797 - Perak Total 4,462 18.97 3,390 14.41 1,072 4.56 Selangor & WP Putrajaya Public 2,884 - 2,785 - 99 - Selangor & WP Putrajaya Private 4,589 - 3,162 - 1,427 - Selangor & WP Putrajaya Total 7,473 13.50 5,947 10.75 1,526 2.76 WP Kuala Lumpur Public 912 - 715 - 198 - WP Kuala Lumpur Private 1,010 - 710 - 300 - WP Kuala Lumpur Total 1,922 11.48 1,425 8.51 498 2.97 Selangor & WP Putrajaya & WPKL Public 3,796 - 3,500 - 297 - Selangor & WP Putrajaya & WPKL Private 5,599 - 3,872 - 1,727 - Selangor & WP Putrajaya & WPKL Total 9,395 13.03 7,372 10.23 2,024 2.81 Negeri Sembilan Public 657 - 422 - 235 - Negeri Sembilan Private 630 - 427 - 203 - Negeri Sembilan Total 1,287 12.60 849 8.31 438 4.29 Melaka Public 997 - 994 - 3 - Melaka Private 408 - 133 - 275 - Melaka Total 1,405 17.11 1,127 13.73 278 3.39 Johor Public 2,523 - 2,489 - 34 - Johor Private 2,736 - 1,675 - 1,062 - Johor Total 5,259 15.71 4,164 12.44 1,096 3.27 Pahang Public 1,004 - 978 - 26 - Pahang Private 341 - 56 - 285 - Pahang Total 1,345 8.96 1,034 6.89 311 2.07 Terengganu Public 1,070 - 1,065 - 5 - Terengganu Private 27 - 27 - 0 - Terengganu Total 1,097 10.59 1,092 10.54 5 0.05 Kelantan Public 1,064 - 876 - 188 - Kelantan Private 85 - 46 - 39 - Kelantan Total 1,149 7.46 922 5.99 227 1.47 Sabah & WP Labuan Public 1,203 - 1,172 - 31 - Sabah & WP Labuan Private 217 - 81 - 136 - Sabah & WP Labuan Total 1,420 4.31 1,253 3.80 167 0.51 Sarawak Public 1,263 - 1,245 - 18 - Sarawak Private 405 - 259 - 146 -

Sarawak Total 1,668 6.75 1,504 6.09 164 0.66 Surgical Services in Malaysian Hospitals

Abbreviation: na – not applicable 5 65 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.5 Number and Density of Total Laparatomies for Trauma and Mastectomies in Malaysia by State and Sector, 2010 Total Laparatomies Laparoscopic Open Procedures Mastectomies For Trauma Procedures State Sector Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. population population population population Malaysia Public 1,631 - 1,567 - 64 - 2,152 - Malaysia Private 712 - 572 - 140 - 1,414 - Malaysia Total 2,343 0.83 2,139 0.75 204 0.07 3,566 1.26 Perlis Public 12 - 12 - 0 - 20 - Perlis Private na na na na na na na na Perlis Total 12 0.52 12 0.52 0 0.00 20 0.86 Kedah Public 61 - 55 - 6 - 105 - Kedah Private 84 - 75 - 9 - 41 - Kedah Total 145 0.74 130 0.67 15 0.08 146 0.75 Kedah & Perlis Public 73 - 67 - 6 - 125 - Kedah & Perlis Private 84 - 75 - 9 - 41 - Kedah & Perlis Total 157 0.72 142 0.65 15 0.07 166 0.76 Pulau Pinang Public 67 - 66 - 1 - 174 - Pulau Pinang Private 43 - 40 - 3 - 276 - Pulau Pinang Total 110 0.70 106 0.68 4 0.03 450 2.88 Perak Public 69 - 69 - 0 - 132 - Perak Private 46 - 46 - 0 - 121 - Perak Total 115 0.49 115 0.49 0 0.00 253 1.08 Selangor & WP Putrajaya Public 514 - 475 - 39 - 342 - Selangor & WP Putrajaya Private 172 - 115 - 57 - 208 - Selangor & WP Putrajaya Total 686 1.24 590 1.07 96 0.17 550 0.99 WP Kuala Lumpur Public 103 - 98 - 5 - 625 - WP Kuala Lumpur Private 132 - 78 - 54 - 281 - WP Kuala Lumpur Total 235 1.40 176 1.05 59 0.35 906 5.41 Selangor & WP Putrajaya & WPKL Public 617 - 573 - 44 - 967 - Selangor & WP Putrajaya & WPKL Private 304 - 193 - 111 - 489 - Selangor & WP Putrajaya & WPKL Total 921 1.28 766 1.06 155 0.22 1,456 2.02 Negeri Sembilan Public 34 - 34 - 0 - 96 - Negeri Sembilan Private 24 - 15 - 9 - 25 - Negeri Sembilan Total 58 0.57 49 0.48 9 0.09 121 1.18 Melaka Public 26 - 26 - 0 - 62 - Melaka Private 84 - 82 - 2 - 128 - Melaka Total 110 1.34 108 1.32 2 0.02 190 2.31 Johor Public 315 - 315 - 0 - 204 - Johor Private 111 - 111 - 0 - 200 - Johor Total 426 1.27 426 1.27 0 0.00 404 1.21 Pahang Public 79 - 79 - 0 - 62 - Pahang Private 0 - 0 - 0 - 33 - Pahang Total 79 0.53 79 0.53 0 0.00 95 0.63 Terengganu Public 39 - 39 - 0 - 45 - Terengganu Private 7 - 4 - 3 - 1 - Terengganu Total 46 0.44 43 0.42 3 0.03 46 0.44 Kelantan Public 49 - 44 - 5 - 84 - Kelantan Private 0 - 0 - 0 - 4 - Kelantan Total 49 0.32 44 0.29 5 0.03 88 0.57 Sabah & WP Labuan Public 179 - 171 - 8 - 106 - Sabah & WP Labuan Private 0 - 0 - 0 - 37 - Sabah & WP Labuan Total 179 0.54 171 0.52 8 0.02 143 0.43 Sarawak Public 84 - 84 - 0 - 95 - Sarawak Private 9 - 6 - 3 - 59 - Sarawak Total 93 0.38 90 0.36 3 0.01 154 0.62 Abbreviation: na – not applicable 66 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.6 Number and Density of Inguinal Hernia Surgeries in Malaysia by State and Sector, 2010 Total Inguinal Hernia Laparoscopic Open Procedures Surgeries Procedures State Sector Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia Public 7,486 - 6,795 - 691 - Malaysia Private 6,634 - 6,108 - 524 - Malaysia Total 14,120 4.98 12,903 4.55 1,215 0.43 Perlis Public 184 - 157 - 27 - Perlis Private na na na na na na Perlis Total 184 7.95 157 6.78 27 1.17 Kedah Public 549 - 515 - 34 - Kedah Private 310 - 284 - 26 - Kedah Total 859 4.41 799 4.10 60 0.31 Kedah & Perlis Public 733 - 672 - 61 - Kedah & Perlis Private 310 - 284 - 26 - Kedah & Perlis Total 1,043 4.79 956 4.39 87 0.40 Pulau Pinang Public 522 - 441 - 81 - Pulau Pinang Private 827 - 625 - 201 - Pulau Pinang Total 1,349 8.64 1,066 6.83 282 1.81 Perak Public 829 - 631 - 198 - Perak Private 697 - 673 - 24 - Perak Total 1,526 6.49 1,304 5.54 222 0.94 Selangor & WP Putrajaya Public 1,156 - 1,073 - 83 - Selangor & WP Putrajaya Private 1,853 - 1,823 - 31 - Selangor & WP Putrajaya Total 3,009 5.44 2,896 5.23 114 0.21 WP Kuala Lumpur Public 503 - 429 - 74 - WP Kuala Lumpur Private 562 - 410 - 152 - WP Kuala Lumpur Total 1,065 6.36 839 5.01 226 1.35 Selangor & WP Putrajaya & WPKL Public 1,659 - 1,502 - 157 - Selangor & WP Putrajaya & WPKL Private 2,415 - 2,233 - 183 - Selangor & WP Putrajaya & WPKL Total 4,074 5.65 3,735 5.18 340 0.47 Negeri Sembilan Public 294 - 253 - 41 - Negeri Sembilan Private 240 - 235 - 5 - Negeri Sembilan Total 534 5.23 488 4.78 46 0.45 Melaka Public 241 - 241 - 0 - Melaka Private 259 - 182 - 76 - Melaka Total 500 6.09 423 5.15 76 0.93 Johor Public 756 - 749 - 7 - Johor Private 1,216 - 1,216 - 0 - Johor Total 1,972 5.89 1,965 5.87 7 0.02 Pahang Public 366 - 312 - 54 - Pahang Private 162 - 160 - 1 - Pahang Total 528 3.52 472 3.14 55 0.37 Terengganu Public 381 - 380 - 1 - Terengganu Private 15 - 15 - 0 - Terengganu Total 396 3.82 395 3.81 1 0.01 Kelantan Public 532 - 517 - 15 - Kelantan Private 70 - 70 - 0 - Kelantan Total 602 3.91 587 3.81 15 0.10 Sabah & WP Labuan Public 548 - 548 - 0 - Sabah & WP Labuan Private 103 - 103 - 0 - Sabah & WP Labuan Total 651 1.98 651 1.98 0 0.00 Sarawak Public 625 - 549 - 76 - Sarawak Private 320 - 312 - 8 -

Sarawak Total 945 3.82 861 3.48 84 0.34 Surgical Services in Malaysian Hospitals

Abbreviation: na – not applicable 5 67 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.7 Number and Density of Total Cholecystectomies and Thyroidectomies in Malaysia by State and Sector, 2010 Total Open Laparoscopic Thyroidectomies Cholecystectomies Cholecystectomies Cholecystectomies State Sector Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. population population population population Malaysia Public 2,924 - 930 - 1,994 - 1,882 - Malaysia Private 6,985 - 1,378 - 5,607 - 3,232 - Malaysia Total 9,909 3.50 2,308 0.81 7,601 2.68 5,114 1.80 Perlis Public 82 - 15 - 67 - 37 - Perlis Private na na na na na na na na Perlis Total 82 3.54 15 0.65 67 2.89 37 1.60 Kedah Public 306 - 55 - 251 - 107 - Kedah Private 271 - 108 - 163 - 70 - Kedah Total 577 2.96 163 0.84 414 2.13 177 0.91 Kedah & Perlis Public 388 - 70 - 318 - 144 - Kedah & Perlis Private 271 - 108 - 163 - 70 - Kedah & Perlis Total 659 3.02 178 0.82 481 2.21 214 0.98 Pulau Pinang Public 186 - 65 - 121 - 113 - Pulau Pinang Private 1,063 - 108 - 955 - 460 - Pulau Pinang Total 1,249 8.00 173 1.11 1,076 6.89 573 3.67 Perak Public 273 - 51 - 222 - 199 - Perak Private 693 - 257 - 436 - 1,017 - Perak Total 966 4.11 308 1.31 658 2.80 1,216 5.17 Selangor & WP Putrajaya Public 447 - 126 - 321 - 354 - Selangor & WP Putrajaya Private 1,534 - 187 - 1,347 - 591 - Selangor & WP Putrajaya Total 1,981 3.58 313 0.57 1,668 3.01 945 1.71 WP Kuala Lumpur Public 227 - 74 - 153 - 219 - WP Kuala Lumpur Private 791 - 192 - 599 - 311 - WP Kuala Lumpur Total 1,018 6.08 266 1.59 752 4.49 530 3.16 Selangor & WP Putrajaya & WPKL Public 674 - 200 - 474 - 573 - Selangor & WP Putrajaya & WPKL Private 2,325 - 379 - 1,946 - 902 - Selangor & WP Putrajaya & WPKL Total 2,999 4.16 579 0.80 2,420 3.36 1,475 2.05 Negeri Sembilan Public 97 - 37 - 60 - 24 - Negeri Sembilan Private 192 - 28 - 164 - 40 - Negeri Sembilan Total 289 2.83 65 0.64 224 2.19 64 0.63 Melaka Public 103 - 41 - 62 - 39 - Melaka Private 423 - 112 - 311 - 118 - Melaka Total 526 6.41 153 1.86 373 4.54 157 1.91 Johor Public 374 - 224 - 150 - 240 - Johor Private 1,393 - 237 - 1,156 - 385 - Johor Total 1,767 5.28 461 1.38 1,306 3.90 625 1.87 Pahang Public 130 - 31 - 99 - 104 - Pahang Private 73 - 29 - 44 - 51 - Pahang Total 203 1.35 60 0.40 143 0.95 155 1.03 Terengganu Public 48 - 26 - 22 - 38 - Terengganu Private 2 - 0 - 2 - 0 - Terengganu Total 50 0.48 26 0.25 24 0.23 38 0.37 Kelantan Public 147 - 24 - 123 - 136 - Kelantan Private 44 - 21 - 23 - 22 - Kelantan Total 191 1.24 45 0.29 146 0.95 158 1.03 Sabah & WP Labuan Public 184 - 55 - 129 - 122 - Sabah & WP Labuan Private 151 - 32 - 119 - 44 - Sabah & WP Labuan Total 335 1.02 87 0.26 248 0.75 166 0.50 Sarawak Public 320 - 106 - 214 - 150 - Sarawak Private 355 - 67 - 288 - 123 - Sarawak Total 675 2.73 173 0.70 502 2.03 273 1.10 Abbreviation: na – not applicable 68 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.8 Number & Density of Postoperative Mortality in Elective & Emergency General Surgeries in Malaysia by State & Sector, 2010 Postoperative Mortality in Postoperative Mortality in Elective Surgeries Emergency Surgeries State Sector Per 10,000 Per 10,000 No. No. population population Malaysia Public 181 - 1,708 - Malaysia Private 52 - 28 - Malaysia Total 233 0.08 1,736 0.61 Perlis Public 1 - 24 - Perlis Private na na na na Perlis Total 1 0.04 24 1.04 Kedah Public 9 - 149 - Kedah Private 0 - 1 - Kedah Total 9 0.05 150 0.77 Kedah & Perlis Public 10 - 173 - Kedah & Perlis Private 0 - 1 - Kedah & Perlis Total 10 0.05 174 0.80 Pulau Pinang Public 10 - 58 - Pulau Pinang Private 8 - 7 - Pulau Pinang Total 18 0.12 65 0.42 Perak Public 44 - 322 - Perak Private 12 - 2 - Perak Total 56 0.24 324 1.38 Selangor & WP Putrajaya Public 15 - 110 - Selangor & WP Putrajaya Private 6 - 1 - Selangor & WP Putrajaya Total 21 0.04 111 0.20 WP Kuala Lumpur Public 54 - 301 - WP Kuala Lumpur Private 11 - 0 - WP Kuala Lumpur Total 65 0.39 301 1.80 Selangor & WP Putrajaya & WPKL Public 69 - 411 - Selangor & WP Putrajaya & WPKL Private 17 - 1 - Selangor & WP Putrajaya & WPKL Total 86 0.12 412 0.57 Negeri Sembilan Public 4 - 14 - Negeri Sembilan Private 0 - 0 - Negeri Sembilan Total 4 0.04 14 0.14 Melaka Public 3 - 43 - Melaka Private 3 - 8 - Melaka Total 6 0.07 51 0.62 Johor Public 4 - 309 - Johor Private 12 - 9 - Johor Total 16 0.05 318 0.95 Pahang Public 3 - 91 - Pahang Private 0 - 0 - Pahang Total 3 0.02 91 0.61 Terengganu Public 8 - 53 - Terengganu Private 0 - 0 - Terengganu Total 8 0.08 53 0.51 Kelantan Public 2 - 80 - Kelantan Private 0 - 0 - Kelantan Total 2 0.01 80 0.52 Sabah & WP Labuan Public 16 - 93 - Sabah & WP Labuan Private 0 - 0 - Sabah & WP Labuan Total 16 0.05 93 0.28 Sarawak Public 8 - 61 - Sarawak Private 0 - 0 -

Sarawak Total 8 0.03 61 0.25 Surgical Services in Malaysian Hospitals

Abbreviation: na – not applicable 5 69 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.9 Number of General Surgeons, General Surgery Trainees, General Surgery Subspecialty Trainees and Theatre Scrub Nurses in Malaysia by State and Sector, 2010 General Surgery General General Surgery Subspecialty Theatre Scrub Nurses Surgeons Trainees Trainees State Sector Per PER Per Per 10,000 Per 10,000 No. No. General No. No. SURGEONS Functioning population population Surgeon (a) OT Malaysia Public 302 - 231 0.76 25 - 2,215 1.59 5.09 Malaysia Private 237 - 0 0.00 0 - 1,453 1.01 4.36 Malaysia Total 539 0.19 231 0.43 25 0.01 3,668 1.30 4.78 Perlis Public 2 - 0 0.00 0 - 27 1.59 5.40 Perlis Private na na na na na na na na na Perlis Total 2 0.09 0 0.00 0 0.00 27 1.59 5.40 Kedah Public 23 - 13 0.57 3 - 142 1.71 5.92 Kedah Private 10 - 0 0.00 0 - 56 1.04 4.67 Kedah Total 33 0.17 13 0.39 3 0.02 198 1.45 5.50 Kedah & Perlis Public 25 - 13 0.52 3 - 169 1.69 5.83 Kedah & Perlis Private 10 - 0 0.00 0 - 56 1.04 4.67 Kedah & Perlis Total 35 0.16 13 0.37 3 0.01 225 1.46 5.49 Pulau Pinang Public 14 - 13 0.93 1 - 128 1.94 5.33 Pulau Pinang Private 28 - 0 0.00 0 - 208 1.17 5.20 Pulau Pinang Total 42 0.27 13 0.31 1 0.01 336 1.38 5.25 Perak Public 15 - 17 1.13 0 - 165 2.04 5.16 Perak Private 14 - 0 0.00 0 - 89 0.79 3.18 Perak Total 29 0.12 17 0.59 0 0.00 254 1.32 4.23 Selangor & WP Putrajaya Public 62 - 22 0.35 11 - 427 1.62 6.37 Selangor & WP Putrajaya Private 63 - 0 0.00 0 - 367 0.98 4.83 Selangor & WP Putrajaya Total 125 0.23 22 0.18 11 0.02 794 1.25 5.55 WP Kuala Lumpur Public 56 - 62 1.11 2 - 445 1.58 6.01 WP Kuala Lumpur Private 46 - 0 0.00 0 - 187 0.57 2.88 WP Kuala Lumpur Total 102 0.61 62 0.61 2 0.01 632 1.03 4.55 Selangor & WP Putrajaya & WPKL Public 118 - 84 0.71 13 - 872 1.60 6.18 Selangor & WP Putrajaya & WPKL Private 109 - 0 0.00 0 - 554 0.79 3.93 Selangor & WP Putrajaya & WPKL Total 227 0.31 84 0.37 13 0.02 1,426 1.14 5.06 Negeri Sembilan Public 10 - 9 0.90 2 - 82 1.95 8.20 Negeri Sembilan Private 10 - 0 0.00 0 - 75 1.34 4.17 Negeri Sembilan Total 20 0.20 9 0.45 2 0.02 157 1.60 5.61 Melaka Public 8 - 5 0.63 0 - 41 1.17 4.10 Melaka Private 13 - 0 0.00 0 - 90 1.11 5.00 Melaka Total 21 0.26 5 0.24 0 0.00 131 1.13 4.68 Johor Public 24 - 11 0.46 2 - 180 1.61 5.45 Johor Private 25 - 0 0.00 0 - 247 2.15 7.48 Johor Total 49 0.15 11 0.22 2 0.01 427 1.88 6.47 Pahang Public 18 - 6 0.33 1 - 105 1.36 4.20 Pahang Private 4 - 0 0.00 0 - 36 1.44 4.00 Pahang Total 22 0.15 6 0.27 1 0.01 141 1.38 4.15 Terengganu Public 5 - 8 1.60 0 - 92 2.24 6.13 Terengganu Private 0 - 0 - 0 - 8 4.00 4.00 Terengganu Total 5 0.05 8 1.60 0 0.00 100 2.33 5.88 Kelantan Public 26 - 47 1.81 2 - 89 0.68 3.71 Kelantan Private 4 - 0 0.00 0 - 13 0.72 4.33 Kelantan Total 30 0.19 47 1.57 2 0.01 102 0.68 3.78 Sabah & WP Labuan Public 18 - 11 0.61 0 - 166 2.18 3.95 Sabah & WP Labuan Private 7 - 0 0.00 0 - 20 0.56 2.50 Sabah & WP Labuan Total 25 0.08 11 0.44 0 0.00 186 1.66 3.72 Sarawak Public 21 - 7 0.33 1 - 126 1.54 2.52 Sarawak Private 13 - 0 0.00 0 - 57 0.90 2.71 Sarawak Total 34 0.14 7 0.21 1 0.00 183 1.26 2.58 (a) Surgeons include surgeons, obstetricians & gynaecologists, opthalmologists, orthopedics surgeons and othrhinolaryngologists. Abbreviation: na – not applicable 70 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.10 Number and Density of Breast Surgeons, Breast and Endocrine Surgeons in Malaysia by State and Sector, 2010 Breast Surgeons Breast and Endocrine Surgeons State Sector Per 10,000 Per 10,000 No. No. population population Malaysia Public 3 - 12 - Malaysia Private 3 - 5 - Malaysia Total 6 0.00 17 0.01 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0.00 Kedah Public 0 - 0 - Kedah Private 0 - 0 - Kedah Total 0 0.00 0 0.00 Kedah & Perlis Public 0 - 0 - Kedah & Perlis Private 0 - 0 - Kedah & Perlis Total 0 0.00 0 0.00 Pulau Pinang Public 0 - 0 - Pulau Pinang Private 1 - 0 - Pulau Pinang Total 1 0.01 0 0.00 Perak Public 0 - 0 - Perak Private 0 - 0 - Perak Total 0 0.00 0 0.00 Selangor & WP Putrajaya Public 1 - 5 - Selangor & WP Putrajaya Private 0 - 2 - Selangor & WP Putrajaya Total 1 0.00 7 0.01 WP Kuala Lumpur Public 2 - 4 - WP Kuala Lumpur Private 2 - 3 - WP Kuala Lumpur Total 4 0.02 7 0.04 Selangor & WP Putrajaya & WPKL Public 3 - 9 - Selangor & WP Putrajaya & WPKL Private 2 - 5 - Selangor & WP Putrajaya & WPKL Total 5 0.01 14 0.02 Negeri Sembilan Public 0 - 0 - Negeri Sembilan Private 0 - 0 - Negeri Sembilan Total 0 0.00 0 0.00 Melaka Public 0 - 0 - Melaka Private 0 - 0 - Melaka Total 0 0.00 0 0.00 Johor Public 0 - 1 - Johor Private 0 - 0 - Johor Total 0 0.00 1 0.00 Pahang Public 0 - 0 - Pahang Private 0 - 0 - Pahang Total 0 0.00 0 0.00 Terengganu Public 0 - 1 - Terengganu Private 0 - 0 - Terengganu Total 0 0.00 1 0.01 Kelantan Public 0 - 1 - Kelantan Private 0 - 0 - Kelantan Total 0 0.00 1 0.01 Sabah & WP Labuan Public 0 - 0 - Sabah & WP Labuan Private 0 - 0 - Sabah & WP Labuan Total 0 0.00 0 0.00 Sarawak Public 0 - 0 - Sarawak Private 0 - 0 -

Sarawak Total 0 0.00 0 0.00 Surgical Services in Malaysian Hospitals

Abbreviation: na – not applicable 5 71 NATIONAL HEALTHCARE ESTABLISHMENTS & WORKFORCE STATISTICS 2010 HOSPITALS

Table 5.11 Number & Density of Vascular Surgeons, Hepatobiliary Surgeons & Colorectal Surgeons in Malaysia by State & Sector, 2010 Hepatobiliary Vascular Surgeons Colorectal Surgeons Surgeons State Sector Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia Public 10 - 18 - 9 - Malaysia Private 9 - 11 - 17 - Malaysia Total 19 0.01 29 0.01 26 0.01 Perlis Public 0 - 0 - 0 - Perlis Private na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 Kedah Public 0 - 2 - 1 - Kedah Private 0 - 0 - 0 - Kedah Total 0 0.00 2 0.01 1 0.01 Kedah & Perlis Public 0 - 2 - 1 - Kedah & Perlis Private 0 - 0 - 0 - Kedah & Perlis Total 0 0.00 2 0.01 1 0.00 Pulau Pinang Public 0 - 1 - 1 - Pulau Pinang Private 2 - 1 - 1 - Pulau Pinang Total 2 0.01 2 0.01 2 0.01 Perak Public 0 - 0 - 0 - Perak Private 0 - 0 - 2 - Perak Total 0 0.00 0 0.00 2 0.01 Selangor & WP Putrajaya Public 2 - 6 - 1 - Selangor & WP Putrajaya Private 4 - 7 - 7 - Selangor & WP Putrajaya Total 6 0.01 13 0.02 8 0.01 WP Kuala Lumpur Public 7 - 6 - 2 - WP Kuala Lumpur Private 1 - 3 - 4 - WP Kuala Lumpur Total 8 0.05 9 0.05 6 0.04 Selangor & WP Putrajaya & WPKL Public 9 - 12 - 3 - Selangor & WP Putrajaya & WPKL Private 5 - 10 - 11 - Selangor & WP Putrajaya & WPKL Total 14 0.02 22 0.03 14 0.02 Negeri Sembilan Public 0 - 0 - 1 - Negeri Sembilan Private 0 - 0 - 1 - Negeri Sembilan Total 0 0.00 0 0.00 2 0.02 Melaka Public 0 - 1 - 0 - Melaka Private 1 - 0 - 0 - Melaka Total 1 0.01 1 0.01 0 0.00 Johor Public 0 - 0 - 1 - Johor Private 1 - 0 - 2 - Johor Total 1 0.00 0 0.00 3 0.01 Pahang Public 1 - 0 - 1 - Pahang Private 0 - 0 - 0 - Pahang Total 1 0.01 0 0.00 1 0.01 Terengganu Public 0 - 0 - 0 - Terengganu Private 0 - 0 - 0 - Terengganu Total 0 0.00 0 0.00 0 0.00 Kelantan Public 0 - 0 - 1 - Kelantan Private 0 - 0 - 0 - Kelantan Total 0 0.00 0 0.00 1 0.01 Sabah & WP Labuan Public 0 - 0 - 0 - Sabah & WP Labuan Private 0 - 0 - 0 - Sabah & WP Labuan Total 0 0.00 0 0.00 0 0.00 Sarawak Public 0 - 2 - 0 - Sarawak Private 0 - 0 - 0 - Sarawak Total 0 0.00 2 0.01 0 0.00 Abbreviation: na – not applicable 72