OBJECTIVE: To examine the relationship between costs of surgery in relation to changes in health status. METHODS: The responses of 10,000 patients to a routine post-discharge survey were evaluated (Health Outcomes Data Repository [HODaR]). Respondents were asked to rate their health both prior to admission and on the day of survey completion (>40 days post-discharge) on a scale of 1 (worst possible health) to 100 (best possible health). Admissions were classified as either elective or emergency procedures. The primary surgical procedure was classified using 3-character OPCS4 codes. The cost for each admission was calculated using the NHS HRG grouping algorithm. RESULTS: ‘Before' and ‘after' data were available for 6456 elective admissions and 1387 emergency admissions who had all undergone a surgical procedure. Mean self-reported difference in health status was 4.8 units (SD 20.7). There was no difference in health change between elective or emergency admissions (p > 0.05). For elective procedures with 25 cases or more (n=45 procedures) a logarithmic relationship between cost and mean health change was evident (DQoL = 6.3024 x Lncost - 36.62; r2 = 0.57), and a linear function best described the same relationship for emergency procedures (DQoL = 0.0022 x cost + 1.4814; r2 = 0.50). Procedures involving a notably improved cost effectiveness ratio included tonsilectomy, cholecystectomy and primary excision of lumbar inter-vertebral disc. The mean cost effectiveness ratio for elective procedures was £250 per DQoL unit and £440 per unit for emergency surgery. CONCLUSIONS: At a macro level there was a distinct association between financial cost and short term outcome for operative procedures. The mean cost effectiveness ratio for individual procedures showed a linear association for emergency surgery and a logarithmic association for elective surgery. Procedures which reduce pain appear to be the most cost-effective where DQoL is the outcome.