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Abstract
        The US leads all other industrialized nations in health care expenditures, now at almost  18% percent of our gross domestic product (GDP), yet healthcare quality in the U.S. is  not significantly better than in countries that spend much less.1 Surgical costs are a major  driver of US health care costs.  An estimated  29%  of the healthcare portion of  GDP  is devoted to surgical costs and this does not include the costs of surgery–related disability or loss of productivity related to poor surgical outcomes.