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Background Non-attendance at outpatient clinics compromises continuity of care, clinic efficiency, and health equity. In Australia, these challenges are amplified in remote settings and among Aboriginal and Torres Strait Islander peoples, yet data on surgical outpatient attendance in such contexts are limited. Methods A retrospective cohort study was conducted of all adult patients scheduled for appointments at a surgical outpatient clinic in Mount Isa, Queensland, Australia, between January 1, 2022, and December 31, 2024. Demographic, geographic, and appointment-related variables were analyzed. Geographic access was assessed using collapsed Modified Monash Model (MMM) categories and distance to clinic. Univariable logistic regression identified predictors of non-attendance, followed by multivariable logistic regression to estimate adjusted associations. Two multivariable models were constructed, incorporating either the MMM category or the distance. Results A total of 6,267 appointments for 2,792 patients were analyzed, with an overall non-attendance rate of 18.3%. In multivariable analysis, Indigenous status was the strongest independent predictor for non-attendance (adjusted OR 3.72, 95% CI 3.22-4.29, p < 0.001). Increasing age was associated with improved attendance (adjusted OR 0.97 per year, p < 0.001). Geographic remoteness and greater travel distance were both associated with higher odds of non-attendance. Telephone (adjusted OR 0.57, 95% CI 0.45-0.71, p < 0.001) and telehealth consultations (adjusted OR 0.62, 95% CI 0.47-0.82, p = 0.001) were associated with reduced non-attendance after adjustment. Female gender showed a reversal from higher unadjusted odds to lower adjusted odds of non-attendance. Conclusion Non-attendance at surgical outpatient clinics in remote Australia is common and is associated with Indigenous status, geographic access, age, and appointment modality. Systemic and logistical barriers to healthcare access continue to disproportionately affect Indigenous patients and those residing further from care, resulting in an unequal burden of missed appointments. Telehealth and telephone consultations are associated with improved attendance and represent important tools that may help mitigate geographic barriers.