Surgeons should note that operating in high-markup hospitals significantly raises patient risks and costs for major surgeries.

• Patients at high-markup hospitals faced 50.3% higher costs and increased odds of in-hospital complications (adjusted odds ratio 1.07).
• Moderate-markup hospitals showed 24.7% higher costs and elevated mortality risks (adjusted odds ratio 1.07).

Surgeons must consider hospital pricing when evaluating surgical options, as care quality and costs vary dramatically.

• High-markup hospitals tend to be larger, urban, and for-profit, impacting patient outcomes and financial accessibility.