In this issue of JAMA Surgery, Jacobs et al1 introduce the use of Desirability of Outcome Ranking (DOOR)2: a novel, alternative composite means of evaluating differences in outcomes among older adult (aged 鈮�65 years) surgical patients presenting to Veterans Affairs (VA). Originally designed to optimize evaluation of antibiotic performance and overcome methodological limitations in clinical trials back in 2015,3 DOOR has since increased in prominence within the infectious disease community2 and expanded to include infectious applications to surgical patients.4 Since 2023, Jacobs and colleagues5,6 have sought to further expand research with DOOR to encompass a broader array of surgical outcomes (eg, mortality, morbidity, readmission) captured within clinical registries (American College of Surgeons National Surgical Quality Improvement Program)5 and linked electronic medical records.6 In their article in this issue of JAMA Surgery, they use Veterans Affairs Surgical Quality Improvement Program data to ascertain whether similar associations between known disparities and DOOR-based differences in surgical outcomes exist, demonstrating worse DOOR scores for racial and ethnic minority older adult veterans living in urban areas with greater proportions of non-VA care. Significant differences based on neighborhood Area Deprivation Index were not found.