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Objective: The true incidence of intraoperative adverse events (iAEs) remains unknown. We aimed to evaluate whether surgeons are willing to voluntarily and accurately report iAEs. Design: Prospective cohort. Setting: Tertiary academic center. Patients: All patients undergoing abdominal surgery between January and July 2016 were included. At the end of surgery, using a secure REDCap database, the surgeon was given the Institute of Medicine definition of iAE and asked whether an iAE occurred. Blinded reviewers then systematically examined all operative reports for iAEs. Main Outcome Measures: The response rate and the iAE rate reported by surgeons were calculated. The latter was compared to the rate of iAEs detected by operative report review. The severity of iAEs was assessed based on a previously validated iAE classification system. Results: A total of 1,989 operations were included. The surgeons’ response rate was 72%, reporting iAEs in 107 operations (7.5%). Of those iAEs, 26 (24.3%) were not described in the operative report. The operative report review revealed iAEs in 417 operations (21%). The surgeons’ response rate was similar in operations with and without iAEs (70% versus 72%, p=0.28), but they underreported low severity iAEs. Table 1 shows that surgeons reported only 13.2% of class I compared to 35.3%, 36.8%, and 55.6% of injury classes II, III, and IV respectively (p<0.001). Conclusions: Surgeons systematically underreported iAEs especially those of lower severity. This is potentially related to the absence of a clear iAE definition and/or their personal interpretation of their clinical significance.