Background: -Orthopaedic surgery has a long and rich history. It is important to recognize the successes and failures of the past, in order to advance research and practice as well as improve patient care, satisfaction and clinical outcomes. The new health care system in the world is moving from a set of purely provider-based systems to receiver-based systems. In this regard, patients' satisfaction is an essential component of quality assessment. In addition, measurement of patient satisfaction plays an important role in the growing push toward accountability among health care providers, which has a significant role in developing and delivering high-quality health care in the hospital. Objective: -To assess the level of satisfaction with orthopedic surgical care and associated factors among adult patients admitted at TGSH. Methods: - Institutional based cross-sectional study was conducted among 238 adult patients admitted at TGSH on Orthopedic ward using simple random sampling technique. The study population was adult patient who admitted at TGSH. Data collection tools was structured questionary with face-to-face interview and patient chart review. Data was analyzed by SPSS. Both bi-variable and multivariable logistic regression analysis was done to evaluate the association. P-value less than 0.05 considered as statistically significant. Result: - Out of 230, above half 124(53.9%) of the participants were satisfied whereas 106(46.1%) were found as unsatisfied. Patient age (AOR 2.935 95%CI: 1.477- 5.833), educational status 2.378(2.378 95%CI :1.043- 5.423), service cost (AOR 95%CI:1.273- 3.807), type of procedure done (AOR 4.583,95% CI :1.409-14.911) and duration of operation time were factors associated with satisfaction level of study participants. Conclusion and recommendation: -The overall satisfaction level on this finding was 53% which is much lower than the national target (80%). The hospital managers should consider institutional factors to modify their provision of services and increase satisfaction of patients.