The Surgical Care Improvement Project (SCIP) was established in 2006 with the goal of reducing surgical complications by 25% in 2010.1 Of the 9 performance measures, 6 are related to surgical site infection prevention.1 Efforts to reduce surgical site infection are important because this complication results in significant morbidity and additional resource use. To this end, the SCIP was designed to improve adherence for prophylactic antibiotic administration, as well as processes related to glucose control, hair removal from the surgical site, and intraoperative normothermia, in patients undergoing elective surgical procedures. It has achieved this goal to the extent that hospitals have successfully implemented these processes. However, what evidence exists demonstrating that improved adherence has achieved the goal of reducing surgical complications?