Background: Bowel obstruction is a global public health problem consuming much in terms of surgical services which varies between regions of the world. It is a common surgical emergency and a significant health problem in Ethiopia. Several factors contribute to poor management outcomes in the case of Bowel obstruction. Aim: The aim of this study was to assess the Operative treatment out comes of bowel obstruction and associated factors in Debre Tabor comprehensive specialized hospital north Central Ethiopia 2021. Methods: Institution based cross sectional study with patients’ chart revision was conducted among operatively managed bowel obstruction cases during January 09 2019 to January 08 2021.The charts of patients were selected using a systematic random sampling technique. A structured research tool was used to collect all the necessary data from the patients’ medical records. the data were analyzed by using SPSS version 25. Frequencies with percentages were used to describe the surgical management outcome of Bowel obstruction. Simple Binary logistic regression and Multiple binary logistic regression model was used to explore the determinant factors associated with the surgical management outcome of Bowel obstruction. Factors at P<0.25 From simple binary logistic regression and P<0.05 from multiple binary logistic regression were declared statically significant. Result:68.4% patients have Good surgical management outcomes of Bowel obstruction, whereas the rest 31.6 % patients have Poor outcomes. Age (AOR: 7.47, 95 CI: (4.57-11.57)), Shock on Arrival (AOR: 11.83, 95 CI: (6.23-15.36)), Preoperative diagnosis (AOR: 15.39, 95 CI:(12.02–20.93)), Blood Transfusion(AOR:46.71, 95CI: (39.56-48.60)), Intraoperative vital sign(AOR: 7.65, 95 CI: (6.88-14.60)), and postoperative vital sign(AOR: 86.68, 95 CI: (79.21-91.08)), were significantly associated. Conclusion: In this study, good surgical management outcomes of Bowel obstruction is lower, and the proportion of patients with poor outcomes was higher. Thus, designing a strategy addressing the significantly associated factors could help to decrease poor surgical management outcome.