This article considers variations in the recording and counting protocols used in the generation of surgical utilization data. A single raw data source was manipulated to reproduce several common protocols to illustrate the statistically significant differences that can result in the volume of surgical utilization considered for both individual procedures and groups of procedures. The results suggest that if recording or counting protocols differ in the samples under consideration, comparison of the statistics and inferences drawn as to utilization therein may be confounded. It is quite possible, therefore, that some of the results of earlier surgical utilization studies may be confounded by such differences in protocols. While there may be valid differences in surgical utilization across different settings, our findings suggest that until methods used in previous work are investigated and reconciled, caution should be exercised in the utilization of this research in public policy making.