Background: Perforated peptic ulcer is a life-threatening complication with a high morbidity and mortality. It is the most common indication for emergency operation and remains a significant healthcare problem, which can consume considerable financial resources.Aim of this study is to assessperioperativesurgical management outcome and associated factors among patients with perforated peptic ulcer disease at tertiary hospitals in BahirDar,Ethiopia, in 2023 Methods:Institution based retrospective study designwas conducted to assess perioperative surgical management outcomes of perforated peptic ulcer disease atTibebeGion Specialized Hospital and FelegeHiwot Specialized Hospitalby reviewing a 4 years datafromSeptember 12, 2019 to September 11, 2023. Results:A total of 118 patients with perforated peptic ulcer disease were operated in a 4 yearperiod. Hundred five (105) (89 %) patients were males and 13(11%) were females with 6.8:1 male to female ratio. The mean and median age of patients was 43.09± 15.34 and 42 years respectively. The peak incidence was between 31 and 45 years (33.1%). Most (81.4%) were from rural area.The mean and median duration of presentation onset of symptom were 42.63 ± 27.394 and 30.50 hours respectively. Most(56.8%) present after 24 hours.Themean and median level of GI contamination was found to be1193.64±1058.72 and 800.00 ml respectively. Duodenalperforation was found in 108 (91.5%) patients. The mean size of perforation was 7.32 ±3.44 mm. Graham's patch was the choice of procedure in all cases. Drain was used in 94.9 % of cases.Postoperative complications occurred in 21 (17.8%) patients and 6(5.1%) patients died before discharge while others discharged improved. The most common complications were SSI (6.8%), pneumonia (3.4%) and re-laparotomy (3.4%).Sizeof perforation is associated with overall adverse outcome, (p=0.022) respectively. Conclusion:Perforated PUD is common among young males. Seventy eight percent of our patients have overall favorable outcome and mortality and morbidity is quite acceptable. Size of perforation significantly associated with overall adverse outcome. Keywords:peptic ulcer disease, perforated peptic ulcer disease, outcome, associated factors, prognostic factors