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Background: There are little primary data available on the delivery or quality of surgical treatment in rural sub-Saharan African hospitals. To initiate a quality improvement system, we characterized the existing data capture at a Ugandan Regional Referral Hospital. Methods: We examined the surgical ward admission (January 2008-December/2011) and operating theater logbooks (January 2010-July 2011) at Mbarara Regional Referral Hospital. Results: There were 6346 admissions recorded over three years. The mean patient age was 31.4 ± 22.3 years; 29.8 % ( n = 1888) of admissions were children. Leading causes of admission were general surgical problems ( n = 3050, 48.1 %), trauma ( n = 2041, 32.2 %), oncology ( n = 718, 11.3 %) and congenital condition ( n = 193, 3.0 %). Laparotomy ( n = 468, 35.3 %), incision and drainage ( n = 188, 14.2 %) and hernia repair ( n = 90, 6.8 %) were the most common surgical procedures. Of 1325 operative patients, 994 (75 %) had an ASA I-II score. Of patients undergoing 810 procedures booked as non-elective, 583 (72 %) had an ASA 'E' rating. Records of 41.3 % (n-403/975) of patients age 5 years or older undergoing non-obstetric operations were missing from the ward logbook. Missing patients were younger (25 [13,40] versus 30 [18,46] years, p = 0.002) and had higher ASA scores (ASA III-V 29.0 % versus 18.9 %, p < 0.001) than patients recorded in the logbbook; there was no diffence in gender (male 62.8 % versus 67.0 %, p = 0.20). Conclusions: The hospital records system measures surgical care, but improved data capture is needed to determine outcomes with sufficient accuracy to guide and record expansion of surgical capacity. [ABSTRACT FROM AUTHOR]