Purpose: Robust clinical trials in Australian surgical practices are integral for progress in evidence-based medicine and optimisation of patient outcomes. This study aimed to examine the methodological quality and diversity of all registered Australian clinical trials in surgery. Methodology: All clinical trials with recruitment in Australia, that were registered as a surgical treatment trial on either The Australian New Zealand Clinical Trials Registry (ANZCTR) or the ClinicalTrials.gov database, between January 2004 to December 2024 were included in this study. Results: 727 studies were identified in the ANZCTR and ClinicalTrials.gov databases and included in the final analyses. A total of 476/727 (65.5%) studies were randomised controlled trials with only 35.4% studies using blinding. Only 5 (0.7%) clinical trials included a focus on Indigenous Australian health outcomes. A total of 227/727 (31.2%) of studies were of the orthopaedic sub-specialty, followed by 191/727 (26.3%) within general surgery. The most frequently listed primary sponsor for the included trials was Hospitals (26.4%), followed by Individuals (20.6%) and the Commercial sector/Industry (20.5%). Of the trials registered, 163 (22.4%) were international trials with recruitment including countries other than Australia Conclusion: Methodological strategies recommended to limit risk of bias, such as randomisation and blinding, were not routinely used in the included clinical trials. Furthermore, very few Australian clinical trials considered Indigenous Australian health outcomes. This study demonstrates that rigorous methodological appraisal and increased diversity in future clinical trials is necessary for the continued investment into Australian surgical practices.