Purpose: Higher surgical volumes are consistently associated with lower postoperative mortality, but the underlying mechanisms remain unclear. Variation in mortality may be driven by differences in complication rates, or by variation in a hospital’s ability to recognise and manage postoperative complications, measured by failure to rescue (FTR). This meta-analysis aimed to quantify the impact of hospital surgical volume on complications and FTR across surgical specialties. Methodology: A systematic review was conducted using MEDLINE, EMBASE, and Scopus, with searches updated to December 2025. Studies examining the association between hospital surgical volume and FTR were included, without restriction on specialty or procedure. Hospital volume categories were categorised into low-, medium-, and high-volume groups. Mixed-effects meta-regression analyses were performed to estimate pooled odds ratios (ORs) for FTR and postoperative complications. Results: Sixty-seven studies encompassing 22,437,468 patients were included. High-volume hospitals were associated with a minimal impact on postoperative complication rates compared to low-volume hospitals (OR 0.93, 95% CI 0.87–1.003, p=0.06). In contrast, high-volume hospitals were associated with significantly lower odds of FTR (OR 0.68, 95% CI 0.63–0.73, p<0.001). The association between higher volume and lower FTR was consistent across surgical specialties, including colorectal (OR 0.72, 95% CI 0.68-0.76), hepatopancreatobiliary (OR 0.57, 95% CI 0.47-0.70), vascular (OR 0.61, 95% CI 0.52-0.71), cardiothoracic (OR 0.75, 95% CI 0.67-0.85), and oesophagogastric surgery (OR 0.60, 95% CI 0.45-0.79). Conclusions: Higher hospital surgical volume is associated with only modest differences in complications but a substantial reduction in FTR. Therefore, the recognition and management of complications represent an important target for quality improvement, particularly in lower-volume settings and where centralisation is not feasible.