This article provides a brief overview of the history of the origin of surgical outcomes studies in North America as exemplified by the career of E. A. Codman, MD. The influence of Harvey Cushing on Codman's interest in documenting the end results of surgical care is reported. The lessons gained from Codman's experience and difficulties are related to the efforts of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Outcomes Committee to develop an international neurosurgical outcome reporting system.