Practice makes perfect. Three words, easily conceptualized, and second nature for any surgeon. It is not surprising that an established and growing body of literature describes improved outcomes when complex surgery is performed by hospitals and surgeons who do those procedures frequently. Luft et al1 published the foundational study in 1979, reporting on 8 complex operations in almost 1 million patients. For some operations, they found a negative association between the number of procedures performed in a hospital and mortality rates. That general finding has been reproduced using a wide range of data sources for a variety of high-risk operations, including those done for head and neck cancer.2