Abstract Aim While the adoption of minimally invasive surgery (MIS) continues to rise, robust evidence comparing its impact on patient outcomes to open surgery (OS) using large-scale, international data remains limited. This study leverages the comprehensive GlobalSurg 1 & 2 datasets to compare MIS and OS across a range of procedures and patient demographics. Method This retrospective cohort study analysed data from 26,228 adult patients within the GlobalSurg 1 & 2 datasets who underwent a surgical procedure between July 2014 and July 2016. Of these, 10,942 underwent MIS and 14,465 underwent OS. Primary outcomes were length of hospital stay and the incidence of postoperative complications. Multivariable regression analysis was conducted to compare outcomes, adjusting for potential confounders. Results Compared to laparoscopic surgery, open surgery was associated with significantly higher odds of major complications (OR: 3.72; 95% CI: 2.85-4.85, p<0.001), surgical site infection (OR:
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