OBJECTIVES: The purpose of this study was to evaluate the methodological quality of economic analyses of surgical procedures, based on the criteria outlined by Blackmore. We based our review on 10 principles derived through comprehensive review of economic analysis methodology published in the medical literature that represent the minimum standards for any medical economic analysis. METHODS: MEDLINE searches identified articles published between 1995 and 2004 that included economic analyses of surgical procedures. The search terms were (‘surgery' OR ‘colorectal surgery' OR ‘plastic surgery' OR ‘thoracic surgery' OR ‘laser surgery') AND (‘cost-effectiveness' OR ‘cost-benefit analysis') limited to age >19 and English language. The preliminary search produced 566 articles. We excluded letters, case reports, review articles, comment articles, and technical notes as well as cost-minimization studies, and articles that mentioned cost-effectiveness as a future study or were not analyses of surgical procedures. 110 articles met all inclusion criteria and were subjected to methodological review. Each article was reviewed independently by one clinician and one researcher and scored for compliance with each of the 10 methodological criteria. Cohen's kappa was used to measure the agreement between the reviewers and consensus was used to determine the final result. RESULTS: The 110 articles included in this study came from 79 different journals, including 57 articles from 37 surgical journals. Most journals (75%) had only one article meeting eligibility criteria. During the time frame of the study, there was no significant change in the number of economic analysis articles published (p value = 0.79). The mean number of criteria met by each article was 4.1 out of the possible 10. The range of compliance with the individual criteria was as high as 93% for ‘Cost Data Provided' and as low as 18% with ‘Statement of Perspective of Analysis'. Overall agreement between reviewers for all criteria had a kappa of 0.78. Ten articles from ten different journals met all ten methodological standards. CONCLUSION: While methodologic guidelines for cost-effectiveness analyses exist and have been published in the medical literature, studies of cost-effectiveness in surgery often do not meet methodologic criteria. This may be improved by wider promulgation of the methodological criteria in surgical journals or at surgical meetings.