Purpose Evaluation is an important tool to appraise the impact and effects of simulation-based education (SBE) programmes. We conducted a systematic review to investigate the global incidence and effectiveness of SBE programmes in low- and middle-income countries (LMICs). In this subset analysis we aimed to ascertain the extent of evaluation in surgical SBE programmes. Methodology We included four databases: Medline, Embase, Emcare and the Cochrane Library. Only studies evaluating Level 4 of the Kirkpatrick model were included, while simulation-based assessment and validation studies were excluded. Results were presented using narrative synthesis. The review was conducted following the PRISMA guidelines. Results After retrieving 27,738 records, 97 studies were included. Of these, 6/97(6%) were conducted in surgery and urology. In total, 9/97(9%) evaluated all levels of the Kirkpatrick model including two studies focusing on surgery. In addition to Kirkpatrick Model Level 4, 82/97(85%) evaluated additional programme outcomes. The majority of studies were from sub-Saharan Africa, 54/97(56%). East Asia and the Pacific accounted for only 13/97(13%) of studies, with no eligible publications from the Pacific Islands. When testing for statistical significance, 61/81(75%) demonstrated at least partial improvement in Level 4 outcomes. Conclusion There is an underutilisation of surgical simulation in LMICs achieving a high level of evaluation. While additional unpublished activities may be occurring, there is a need to conduct and publish more robust research to evaluate the effectiveness of surgical simulation in these settings.