ABSTRACT Background: Elective surgical case cancellation refers to any elective surgical casethat is booked into the operation theatre list on the day prior to surgery, but is not operated upon as scheduled. Elective surgical case cancellation is common and canhave significant adverse effects. The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. Reasonsfor cancellations are complex because they are related to patients, organizational issues, and clinical staff. OBJECTIVE: To assess Magnitude of Elective Surgical Case Cancellation and Its Associated Factors among Elective Surgical Cases at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia from September 1, 2025 to January 30, 2026. Methods: Institution based Prospective study design was used.A structured research tool was used to collect all necessary data from daily schedule list. The collected data were entered into Kobo Toolbox, and thenexported to SPSS version 23 for analysis and descriptive statistics was used to present the result. All elective surgical cases scheduled but canceled due to some reason (n=107) to undergo elective surgical procedures were included in this study. Result: A total of 1150 patients were scheduled for elective surgical operations. Of these, 107(9.30%) were canceled. About 61(57 %) of males and 46(43 %) of females were cancelled. Orthopedic surgery had the highest rate of cancellations 25(23.36%) followed by Urological surgery 18(16.82%).Of the cancellations, 29 (27.10%) were due to management-related reasons, 24 (22.43%) were due to medical illness, and 17 (15.89%) were due to lack of time Conclusion and Recommendation: Management related, medical illness, and shortage of time were the main causes of cancellation of elective surgical operations in our hospital during the study period. Concerned bodies should bring a sustainable change and improvement to prevent unnecessary cancellations and enhance cost effectiveness through communications, careful preoperative planning, and efficient utilization of time management and available hospital resources.