Background: The use of traditional medicine (TM) in South Africa is reportedly high. TM use in a South African surgical population presenting for elective surgery is unknown. Aim: The study aim was to survey the perioperative usage of TM in a South African population presenting for elective surgery at a tertiary hospital. Methods: A prospective, contextual and descriptive study was carried out on adults presenting for elective surgery at a tertiary South African hospital. Results: During a 2 month study period 495 patients were interviewed (97% response rate). The mean age was 46.6 years (SD 14.8) with 34% male and 66% female. Patients underwent orthopaedic (42%), general (32%) and gynaecological (26%) surgery. Fifty per cent of the participants were on chronic medication. Thirty-nine per cent of participants reported past TM use and 7% admitted to current TM use. The most common reason for TM was for cleansing purposes (41%) followed by pain (17%). Seven (4%) participants reported adverse events attributed to TM use with 46% unsure whether an adverse event occurred. Factors associated with current TM use were planned surgical procedure (p-value = 0.009), known positive HIV status (p-value = 0.04), and current arthritic medication use (p-value = 0.002). Conclusion: Perioperative TM use is clinically relevant and should be considered in elective surgical patients. However, TM use in the current survey was found to be lower than that quoted in the literature.