Background <p>Asian studies presents conflicting conclusions regarding the prognostic benefits of perioperative tight glycemic control (TGC) versus conventional glycemic control (CGC) in abdominal surgery. This systematic review and meta-analysis synthesizes current evidence to resolve these clinical discrepancies.</p> Methods <p>A systematic search across major databases (PubMed, Web of Science, EMBASE, Cochrane, etc.) identified randomized controlled trials assessing perioperative TGC’s impact on abdominal surgery patient prognosis.</p> Results <p>This meta-analysis, encompassing 30 studies with 2,709 patients, demonstrates that perioperative TGC significantly reduces the incidence of surgical site infections, respiratory tract infections, overall complications, and hypoglycemia in patients undergoing abdominal surgery. While publication bias was noted for overall complications and heterogeneity for hypoglycemia, neither affected the conclusions. TGC’s potential to reduce wound healing time and hospital stay is attenuated by publication bias, while the conclusion on length of stay is further confounded by significant data heterogeneity. No difference was observed in the incidence of urinary tract infections.</p> Conclusion <p>Compared to perioperative CGC, perioperative TGC, which maintains blood glucose levels at 4.44–6.67 mmol/L, can significantly improve the prognosis of patients undergoing abdominal surgery.</p>