The contest's tie-break procedure was implemented for the first time in its history, which resulted in Sweden being declared the winner due to their entry, "Fångad av en stormvind", written by Stephan Berg and performed by Carola, having received a greater number of top scores from the other competing countries than the French entry; it was Sweden's third contest victory overall.

[4][5][6] The choice of Sanremo and Ariston as host of the event was initially rejected by the EBU, citing concerns regarding the size of the venue as well as organisational and security shortcomings.

[8][9][10] Although plans to hold the contest in Sanremo continued to be developed as late as January 1991, by February doubts over the feasibility of holding the event in Sanremo became insurmountable, due to instability in the Middle East and the outbreak of the Gulf War, and ultimately the organisers opted to relocate the contest to a more secure location, eventually confirming on 18 February that the event would be held in Rome.

[5][7][11] Despite the relocation Sanremo remained a partner of the 1991 contest and pre-recorded footage of the city was featured during the live broadcast.

[14] Several artists that had previously competed in the contest returned to participate in this year's event: Stefán Hilmarsson, who competed alongside Eyjólfur Kristjánsson [is] for Iceland, was a member of Beathoven that had participated for the nation in 1988; Thomas Forstner made a second appearance for Austria following the 1989 contest; Carola also returned to the contest for the second time for Sweden after her participation in 1983; and the members of Norway's Just 4 Fun featured two previous participating artists, namely Eiríkur Hauksson, who had competed in the 1986 for Iceland as part of the group ICY, and Hanne Krogh, who had represented Norway twice before, in 1971 as a solo artist and in 1985 as a member of the group Bobbysocks!, the latter appearance ultimately winning the contest outright.

[15] On behalf of the contest organisers, the European Broadcasting Union (EBU), the event was overseen by Frank Naef as scrutineer.

The voting sequence was also notably haphazard and several mistakes required rectification during the show, with the EBU's executive supervisor Frank Naef regularly called upon by the hosts for clarification.

[28] The points awarded by each country were determined by an assembled jury of sixteen individuals, which was required to be split evenly between men and women and by age.

The votes of each member were collected following the country's performance and then tallied by the non-voting jury chairperson to determine the points to be awarded.

In any cases where two or more songs in the top ten received the same number of votes, a show of hands by all jury members was used to determine the final placing.

[29][30] In a change to the rules compared to previous editions, half of the jury members in each country were now represented by music experts, comprising among other professions singers, composers, lyricists, musicians, conductors, music journalists, record company employees and radio or television producers.

The show was presented by the Italian singers Gigliola Cinquetti and Toto Cutugno, the two artists which up until this point had won the contest for Italy, in 1964 and 1990 respectively.

[6][36] The winner was Sweden represented by the song "Fångad av en stormvind", written by Stephan Berg and performed by Carola.

[26] Broadcasters were able to send commentators to provide coverage of the contest in their own native language and to relay information about the artists and songs to their television viewers.

[48][49][50] In addition to the participating countries, the contest was also reportedly broadcast in Bulgaria, Czechoslovakia, Hungary, Poland, Romania and the Soviet Union via Intervision, and in Australia, Cape Verde, Guinea-Bissau, Mozambique, South Africa and South Korea, with an estimated global audience of up to 800 million viewers.