Globally, there are few studies comparing perioperative mortality following abdominal surgery across different health systems. One major prospective study of 10,745 adult patients undergoing emergency laparotomy from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. In this study the overall global mortality rate was 1.6 per cent at 24 hours (high 1.1 per cent, middle 1.9 per cent, low 3.4 per cent; P < 0.001), increasing to 5.4 per cent by 30 days (high 4.5 per cent, middle 6.0 per cent, low 8.6 per cent; P < 0.001). Of the 578 patients who died, 404 (69.9 per cent) did so between 24 h and 30 days following surgery (high 74.2 per cent, middle 68.8 per cent, low 60.5 per cent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days.. Was the overall global mortality rate higher at 24 hours or 30 days?