Background: Surgery is an important public health intervention and occurs at a tremendous volume worldwide from the most resource rich to the most resource limited settings. This volume of surgery needs a great effort to improve the safety and availability of surgical services that will be sumed-up with good patient outcome. Even though adverse patient outcomes following gastrointestinal surgery is among the leading causes of morbidity and mortality, in Ethiopia limited studies have been conducted so far on the outcome of gastrointestinal surgery. Objective: To assess the outcome and associated factors of patients underwent gastro-intestinal surgery at Tibebe Ghion specialized Hospital, Bahir Dar, Ethiopia 2022. Methods: Institution-based retrospective cross-sectional study was conducted on records of patients treated at Tibebe Ghion specialized Hospital from January 8, 2020 to January 7, 2022. Secondary data were collected by using Pre-tested checklist from the patient charts. Data were entered into the Epi data version 4.6 and exported to SPSS version 25 for further analyses. A binary logistic regression model was used to identify the associated factors. Variables with P- value < 0.25 in the bivariable analysis was a candidate for multivariable analysis and P-value <0.05 in the multivariable analysis was used to declared as statistically significant. Results: From a total of 403 patients, 87 (21.6%) developed poor outcome of gastrointestinal surgery. Rural residency (AOR=3.21), morbidity status greater than or equal to ASAII (AOR=0.32), comorbid illness (AOR=3.67), post-operative length hospital of stay greater than or equal seven days (AOR=4.27), WHO surgical safety checklist utilization (AOR=3.14) and length of operating time (AOR=3.31) were significantly associated with poor outcome of GI surgery. Conclusion and recommendations: More than one-fifth of patients treated at Tibebe Ghion Specialized Hospital, experienced poor surgical outcome. Shortening hospital stays, effectively managing patients with comorbidities, and increasing awareness for rural populations can reduce the problem. Key words: Surgical outcome, gastrointestinal surgery, Tibebe Ghion Specialized Hospital, Ethiopia ABBREVIATIONS AND ACRONYMS