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We hypothesized that mortality and surgical complication rates would be higher for patients who underwent four common surgical procedures in Canada as compared to the US.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>We conducted a retrospective cohort study of all adults who underwent hip fracture repair, colectomy, pancreatectomy, or spine surgery in 96 Canadian and 585 US hospitals participating in the American College of Surgeons National Surgical Quality Improvement Project (ACS\u2010NSQIP) between January 1, 2015 and December 31, 2019. We compared patients with respect to demographic characteristics and comorbidity. We then compared unadjusted and adjusted outcomes within 30\u2010days of surgery for patients in Canada and the US including: (1) Mortality; (2) A composite constituting 1\u2010or\u2010more of the following complications (cardiac arrest; myocardial infarction; pneumonia; renal failure\/; return to operating room; surgical site infection; sepsis; unplanned intubation).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our hip fracture cohort consisted of 21,166 patients in Canada (22.3%) and 73,817\u00a0in the US (77.7%), for colectomy 21,279 patients in Canada (8.9%) and 218,307 (91.1%), for pancreatectomy 873 (7.8%) in Canada and 12,078 (92.2%) in the US, and for spine surgery 14,088 (5.3%) and 252,029 (94.7%). Patient sociodemographics and comorbidity were clinically similar between jurisdictions. In adjusted analyses odds of death was significantly higher in Canada for two procedures (colectomy (OR 1.22; 95% CI 1.044\u20131.424; <jats:italic>P<\/jats:italic>\u2009=\u2009.012) and pancreatectomy (OR 2.11; 95% CI 1.26\u20133.56; <jats:italic>P<\/jats:italic>\u2009=\u2009.005)) and similar for hip fracture and spine surgery. Odds of the composite outcome were significantly higher in Canada for all 4 procedures, largely driven by higher risk of cardiac events and post\u2010operative infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found evidence of higher rates of mortality and surgical complications within 30\u2010days of surgery for patients in Canada as compared to the US.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-022-06444-w","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T19:02:57Z","timestamp":1643655777000},"page":"1039-1050","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Surgical Outcomes in Canada and the United States: An Analysis of the ACS\u2010NSQIP Clinical Registry"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1910-346X","authenticated-orcid":false,"given":"Peter","family":"Cram","sequence":"first","affiliation":[{"name":"Department of Medicine University of Toronto Toronto ON Canada"},{"name":"Division of General Internal Medicine and Geriatrics Sinai Health System and University Health Network Toronto ON Canada"},{"name":"ICES Toronto ON Canada"},{"name":"University of Texas Medical Branch Galveston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Cohen","sequence":"additional","affiliation":[{"name":"American College of Surgeons Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Ko","sequence":"additional","affiliation":[{"name":"American College of Surgeons Chicago IL USA"},{"name":"UCLA Department of Surgery Los Angeles CA USA"},{"name":"Los Angeles VA Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce E.","family":"Landon","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School and Division of General Medicine, Beth Israel Deaconess Medical Center Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Hall","sequence":"additional","affiliation":[{"name":"American College of Surgeons Chicago IL USA"},{"name":"Department of Surgery School of Medicine Washington University St Louis MO USA"},{"name":"St Louis VA Medical Center St Louis MO USA"},{"name":"BJC Healthcare St Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Toronto Toronto Canada"},{"name":"Division of General Surgery University Health Network Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.1152"},{"key":"e_1_2_5_3_1","unstructured":"PadgetM BiondiN BrownwoodI. 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