Millions of operations take place in the UK each year; the majority occurring without undue patient morbidity. However, dependant on the nature of the procedure, post-operative morbidity is not uncommon and we will all recall patients who have suffered an unexpected complication after surgery. Large epidemiological studies have suggested that post-operative morbidity is not confined to the discrete episode of post-operative care, and in fact may have a significant impact on a patient's long-term mortality. Dr Ramani Moonesinghe from the UCL/UCLH Surgical Outcomes Research Centre talks to us about her work in this area, pre and post-operative scoring systems and the post-operative morbidity domains significantly associated with decreased survival after surgery, as well as what we can do as peri-operative physicians to influence longer-term patient outcomes.