This chapter explores the structure, operations, and financial performance of the surgical service line, emphasizing the integration of clinical excellence, operational efficiency, and strategic management in perioperative medicine. It defines the service line as a coordinated framework encompassing preoperative, intraoperative, and postoperative care, where anesthesiologists and surgeons play central roles in optimizing outcomes and resource utilization. From a clinical perspective, this chapter highlights risk assessment, patient optimization, and evidence-based practices that align with high reliability organization (HRO) principles. Operationally, it examines methodologies such as Time-Driven Activity-Based Costing (TDABC), process mapping, and key performance indicators (KPIs) to enhance throughput and reduce variability. Financially, it introduces analytic tools like DuPont Analysis and Balanced Scorecards to align profitability with quality metrics and strategic goals. The chapter underscores that successful perioperative management requires collaboration among clinicians, administrators, and executives to create transparent, value-driven systems capable of adapting to changing market forces and regulatory demands while maintaining patient-centered care.