Variations in outcomes for patients who have surgery are well known, and there is extensive evidence that failure to apply standards of care known to prevent adverse events results in patient harm. Infections and postoperative sepsis, cardiovascular complications, respiratory complications, and thromboembolic complications represent some of the most common adverse events that occur after surgery. Patients who experience postoperative complications have increased hospital length of stay, readmission rates, and mortality rates; in addition, costs of care are increased for patients, hospitals, and payers. In 2002, the Centers for Medicare and Medicaid Services, in collaboration with the Centers for Disease Control and Prevention, implemented the Surgical Infection Prevention Project to decrease the morbidity and mortality associated with postoperative surgical site infections. More recently, the Surgical Care Improvement Project, a national quality partnership of organizations committed to improving the safety of surgical care has been implemented. Although the Surgical Care Project does not focus on the complete set of important surgical quality issues, it does provide the incentive and infrastructure for national data collection and quality improvement activities for hospitals. There is now a strong national commitment to measure processes and outcomes of care for surgery in the United States.