Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.