Background <p>Perioperative mortality in children continues to be a major concern, with rates significantly exceeding those observed in adults. This issue remains despite improvements in anesthesia, surgical, and perioperative management. The aim of this systematic review and meta-analysis is to generate evidence regarding perioperative pediatric mortality in Ethiopia.</p> Methods <p>This systematic review was conducted in strict adherence to the PRISMA 2020 guidelines. A thorough literature search was undertaken to identify published and unpublished English-language studies. Electronic databases, including PubMed, African Journals Online, Cochrane Library, and CINAHL, were systematically searched to capture relevant studies for inclusion. The methodological quality of the selected studies was appraised using the Joanna Briggs Institute critical appraisal tools. Data analysis was performed using Stata version 17, whereby the pooled incidence of perioperative pediatric mortality was calculated, and potential predictors were examined.</p> Results <p>A total of 23 studies, comprising 7,059 participants, were included in this analysis. The pooled incidence of perioperative pediatric mortality was found to be 15.81% (95%CI: 11.82–19.79). Factors significantly associated with elevated perioperative pediatric mortality included neonatal surgery (pOR = 8.65; 95%CI: 4.06–18.45), pediatric trauma surgery (pOR = 8.07; 95%CI: 4.66–13.98), delayed presentation and surgical intervention following the onset of disease (pOR = 4.41; 95%CI: 2.02–9.62), prolonged hospital stays (pOR = 3.46; 95%CI: 2.10–5.68), and emergency surgery (pOR = 2.35; 95%CI: 1.80–3.08).</p> Conclusion <p>The meta-analysis indicates that perioperative pediatric mortality in Ethiopia is elevated. Significant factors include pediatric trauma surgery, emergency surgery, delayed presentation and intervention following disease onset, prolonged hospital stay, and neonatal surgery.</p>