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To evaluate whether the perception of safety of surgical practice among operating room (OR) personnel is associated with hospital-level 30-day postoperative death.The relationship between improvements in the safety of surgical practice and benefits to postoperative outcomes has not been demonstrated empirically.As part of the Safe Surgery 2015: South Carolina initiative, a baseline survey measuring the perception of safety of surgical practice among OR personnel was completed. We evaluated the relationship between hospital-level mean item survey scores and rates of all-cause 30-day postoperative death using binomial regression. Models were controlled for multiple patient, hospital, and procedure covariates using supervised principal components regression.The overall survey response rate was 38.1% (1793/4707) among 31 hospitals. For every 1 point increase in the hospital-level mean score for respect [adjusted relative risk (aRR) 0.78, 95% CI 0.65–0.93, P = 0.0059], clinical leadership (aRR 0.86, 95% CI 0.74–0.9932, P = 0.0401), and assertiveness (aRR 0.71, 95% CI 0.54–0.93, P = 0.01) among all survey respondents, there were associated decreases in the hospital-level 30-day postoperative death rate after inpatient surgery ranging from 14% to 29%. Higher hospital-level mean scores for the statement, “I would feel safe being treated here as a patient,” were associated with significantly lower hospital-level 30-day postoperative death rates (aRR 0.83, 95% CI 0.70–0.97, P = 0.02). Although most findings seen among all OR personnel were seen among nurses, they were often absent among surgeons.Perception of OR safety of surgical practice was associated with hospital-level 30-day postoperative death rates.