Study Design. Literature review of complications unrelated directly to surgical skills involved in spinal deformity surgery. Objective. Highlight complications associated with perioperative issues. Summary of Background Data. Complications can arise from mundane events that arise during the operative experience, but are not directly related to surgical skills. Methods. Literature reviews that touches on the more common potential complication events that do not involve direct surgical expertise. Results. The topics of positioning, nutrition, blood loss, comorbidities, OR time, and pulmonary and GI concerns are discussed as basics that could derail a surgical outcome even with an otherwise uneventful surgical technique. The need for vigilance is stressed and the nuances of understanding these are discussed. Conclusion. Mundane events can derail a perfectly executed surgical undertaking. Attention to detail, team work, close monitoring, and checklist type focus will help to improve, focus, and avoid these preventable complications that have nothing to do with direct surgical skills.