Data from 56 countries showed that in 2004 the annual volume of major surgery was an estimated 187–281 million operations, or approximately one operation annually for every 25 human beings alive (3). This is a large and previously unappreciated volume with significant implications for public health. It is almost double the annual volume of childbirths— in 2006, there were approximately 136 million births (4)—and is at least an order of magnitude more dangerous. While the rates of death and complications after surgery are difficult to compare since the case mix is so diverse, in industrialized countries the rate of major complications has been documented to occur in 3–22% of inpatient surgical procedures, and the death rate 0.4–0.8% (5,6). Nearly half the adverse events in these studies were determined to be preventable.