Every year, around 300 million surgical procedures are performed worldwide (1,2), with an estimated 4% early postoperative mortality rate.(3,4) However, little is known about global quality of surgery, specifically in middle-income countries.Colombia, similar to other Latin American countries, has an interesting diversity of healthcare needs.In urban settings, the healthcare offered is among the best in Latin America, with top-quality hospitals and educational programs comparable to those in the USA or Europe.In contrast, in most rural areas of Latin America, including some of the most remote locations in the world (like the Pacific Coast or the Amazon forest), a frail and fragmented healthcare system prevails, similar to the conditions in very low-income countries.At least 7.1 million people (15.1% of the population) lack hospital access within a 2-hour drive, and despite these characteristics, the early reported postoperative mortality is low -0.74% .( 5) This diversity represents a major challenge for an appropriate unbiased estimation of perioperative mortality.Additionally, it is important to understand how external factors at the macro level, including economic and administrative issues, social conditions, technological changes and health care inequalities, may influence clinical performance and quality of surgical care.( 6)The Covid-19 pandemic has overwhelmed many health and social systems globally, resulting in a significant number of deaths, both directly and indirectly.One of the major concerns of surgical OPEN