Postoperative morbidity has a significant effect on quality of life and survival.^1,2 Thus, quality improvements (QI) in surgical care aim to reduce complications through well-established systems^3-5 designed for early risk detection. Since its advent in 1985,⁶ the Veterans Affairs Surgical Quality Improvement Program (VASQIP) has revolutionized the way we operationalize quality initiatives. Chen et al⁷ tested the resilience of VASQIP-sampled, facility-level adjusted outcomes as an accurate representation of overall facility performance. Their findings demonstrate that existing sampling strategies underrepresent outlier facilities, diminishing effective mitigation measures and highlighting the potential for adverse postoperative events in at-risk programs.