Retrospective analysis of general surgery outcomes in multicenter cohorts in Saudi Arabia.

General surgery outcomes remain a concern despite advancements in techniques, anesthesia, and perioperative care. Achieving consistent, high-quality results and accurately predicting risks remains challenging. This study aimed to identify factors associated with adverse outcomes through a retrospective analysis of general surgery cases across multiple centers in Saudi Arabia. A retrospective cohort study analyzed 14,635 medical records of patients who underwent general surgery across multiple centers in Saudi Arabia from 2010 to 2020. Data from the General Directorate of Health Affairs registry included demographics, comorbidities, procedure details, and outcomes. The study focused on risk factors for 30-day mortality and complications, with subgroup analyses comparing outcomes across facilities. Common surgeries included hernia repair, cholecystectomy, appendectomy, and bowel resection. The overall 30-day mortality rate was 0.74%, and the complication rate was 11.1%. Independent predictors of mortality were ASA grade III/IV, Charlson index ≥3, cardiovascular disease, dementia, renal disease, and longer procedures. Teaching hospitals had lower mortality and complication rates. Complication predictors included older age, ASA III/IV, diabetes, cardiac disease, and high-risk procedures. Evening surgeries were associated with fewer complications. This multicenter study identified patient risk factors and procedure characteristics that predict 30-day outcomes after general surgery. Older age, multiple comorbidities, and high-risk surgeries were linked to poorer outcomes. Teaching centers had better results, emphasizing the role of institutional factors. These findings can guide risk stratification and quality improvement efforts to enhance recovery and provide a foundation for future research to improve surgical practices globally.