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.