Purpose: Emergency laparotomy is associated with substantial morbidity and mortality. While national audits such as ANZELA-QI have driven quality improvement across Australia and New Zealand, data from rural New Zealand centres remain limited. This study audited emergency laparotomy outcomes and processes of care at a regional New Zealand hospital and compared them with ANZELA-QI benchmarks. Methodology: A retrospective audit was conducted of all adult patients undergoing emergency laparotomy or laparoscopy at Taranaki Base Hospital between September 2023 and September 2025. Inclusion and exclusion criteria mirrored those of ANZELA-QI. Data collected included demographics, operative details, consultant involvement, radiology, timeliness to theatre, postoperative outcomes, and 30-day mortality. Outcomes were compared descriptively with ANZELA-QI benchmarks. Results: A total of 126 patients were included (median age 67 years; 50.8% female). Preoperative CT scanning was performed in 96% of cases, with 95.2% reported by a consultant radiologist. Surgery occurred within the assigned urgency timeframe in 86.3% of cases. Consultant surgeons were present in 88.9% of operations, and consultant anaesthetists in 100%. Preoperative risk assessment was documented in only 4% of patients. Postoperatively, 42.9% were admitted to critical care and 7.1% returned to theatre. Overall 30-day mortality was 10.3%. Of those alive at discharge, 92.9% returned to their prehospital residence. Only 17.1% of patients aged ≥65 years received geriatric assessment. Conclusion: Emergency laparotomy outcomes at this rural New Zealand hospital were comparable to national and international benchmarks, with strong performance in radiology access, consultant involvement, and timeliness to theatre. Key areas for improvement include routine documentation of preoperative risk assessment and increased geriatric involvement for older patients. Rural-specific audits remain essential to inform equitable, high-quality surgical care.