Purpose Aboriginal and Torres Strait Islander peoples experience major health inequities; however, emergent surgical outcomes are not well defined. We compared the short term outcomes following an emergent laparotomy of indigenous and non indigenous patients at a regional Australian hospital. Methodology We conducted a retrospective cohort study of adult emergency laparotomies at Cairns Hospital between 2020 and 2024. Indigenous status was obtained from hospital records. The outcomes measured were surgical site infection (SSI), return to theatre and length of stay (LOS). Multivariable logistic regression adjusted for age, body mass index (BMI), diabetes, smoking, immunosuppression, bowel resection, peritoneal contamination and operative time. A 1:1 nearest neighbour propensity score–matched analysis without replacement was used to compare indigenous and non-indigenous patients with similar baseline and operative characteristics. Results Of 527 patients, 96 (18.2%) were indigenous and 431 (81.8%) non indigenous. Indigenous patients were younger (mean 50 vs 62 years) but more likely to have diabetes (24% vs 11%) and to be current smokers (54% vs 25%), with similar BMI and operative time; bowel resection was less frequent (41% vs 56%). In adjusted models, indigenous status was not associated with SSI (adjusted odds ratio [aOR] 1.13, 95% CI 0.65–1.94) or return to theatre (aOR 0.85, 95% CI 0.48–1.53). In the matched cohort (94 indigenous, 94 non indigenous), SSI (31.9% vs 29.8%; p=0.87) and return to theatre (29.8% vs 30.9%; p=1.00) remained similar. Conclusion In this emergency laparotomy cohort, Aboriginal and Torres Strait Islander status was not independently associated with worse short term surgical outcomes once baseline and operative factors were accounted for.