It has long been recognized that major head and neck surgery isassociated with a significant rate of postoperative complications. These,in turn, are associated with a significant burden of patient suffering aswell as increased healthcare costs. Unfortunately, this aspect of headand neck surgery has been poorly studied suggesting a degree ofcomplacency on the part of the head and neck surgical community. Thispresentation is deliberately a provocative one aimed at engenderingdiscussion and collaboration in what has been a relatively neglectedarea of clinical investigationPostoperative complications have their genesis in the interactionbetween three groups of variables: the patient acute and chronicco-morbidity present at the time of surgery, the magnitude of thesurgical insult, and the entire perioperative care package aspects ofwhich may mitigate for, or against, complications.Our prospective experience, in patients undergoing major surgerywith free flap repair over 27 months between 2009 and 2011 (n=192),demonstrated a low perioperative mortality but high associatedmorbidity. This has resulted in a number of on-going efforts to improvethe quality of care we provide in an effort to reduce both the number,and severity, of morbid events. The evolution of the strategies employedand future directions will also be discussed.