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Objective: Cost-analysis research can influence healthcare and practice policies. There are three major perspectives in cost analysis research: the third-party payer, the hospital, and societal. This study performed a review of cost-analysis studies in the general surgery literature to determine the prevalence of studies declaring and justifying their cost perspective, and to inform readers of potential bias in the results. We hypothesize that there is underreporting of cost perspectives which may hide bias and introduce ethical concerns. Design: Systematic review in accordance with PRISMA guidelines. Setting: Cost-utility and cost-effectiveness studies in the general surgical literature in North America and Europe from 2012-2016. Patients: Surgical patients. Interventions: N/A. Main Outcome Measures: Presence of stated cost perspective, accuracy of stated cost perspective, justification of stated cost perspective. Results: We identified 1398 abstracts through Medline and bibliography reviews, of which 207 met inclusion criteria. Seventy-four percent of studies (n=153) declared a cost perspective. Thirty-eight percent of studies either did not declare a cost perspective or incorrectly stated their perspective. Only 30% of studies (n=63) both accurately identified and justified their cost perspective. Conclusions: While some cost-analysis studies provide clear cost perspective and justification, many do not. Studies that draw conclusions regarding cost-effectiveness without addressing cost perspective pose ethical concerns, leading readers to misinterpret or not consider which costs are, or should be, included in these analyses. Our review emphasizes that future cost-analyses require clear declaration and justification of cost perspective to avoid potentially inaccurate and unethical presentations of data.