Background <p>Obstructive jaundice has contributed a sizable burden of global mortality, morbidity, economic cost, and hospitalization worldwide cause by benign and malignant conditions.</p> Objective <p>To assess the etiological pattern, predictors for postoperative complications, and short-term outcomes <i>among patients undergoing surgical intervention for EHBO</i> at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia, 2024.</p> Methods <p>A hospital-based retrospective cohort study was conducted to evaluate the etiological patterns, outcomes, and predictors of complications following surgical intervention for extrahepatic biliary obstruction (EHBO). The study included 122 EHBO patients who were consecutively enrolled during the study period. Normality of continuous variables was assessed using the Shapiro-Wilk test; normally distributed data were expressed as means with standard deviations, whereas skewed variables were reported as medians with interquartile ranges. Univariate and multivariate binary logistic regression analyses were performed to identify predictors of 30-day postoperative complications. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI), and a p-value &lt; 0.05 was considered statistically significant.</p> Results <p>Among 122 patients undergoing surgical intervention for EHBO, the mean age was 51.8 years (SD 13.2), with a slight male predominance (53.3%). Most patients had good performance status (ECOG 0–1 in 91.8%). Malignant biliary obstruction (MBO) was present in 67 (54.9%), predominantly due to pancreatic cancer (23.0%) and periampullary tumors (18.9%). In MBO patients, mean serum bilirubin decreased from 18.8&#xa0;mg/dL preoperatively to 1.7&#xa0;mg/dL at 4 weeks, representing a 90.1% reduction. Curative resection was achieved in 22 (32.8%) patients (Whipple procedure in 19, bile duct excision in 3); the remainder underwent palliative surgery. The 30-day postoperative complication rate was 25.4% (31/122), with mortality of 1.6% (2/122). Surgical site infection was the most frequent complication (19.7%), followed by anastomotic leakage (6.6%). Multivariable analysis identified poorer ECOG status (AOR 6.1, 95% CI 2.0–18.4; <i>p</i> = 0.001) and jaundice duration &gt; 8 weeks (AOR 2.1, 95% CI 1.7–6.3; <i>p</i> = 0.003) as independent predictors of postoperative complications.</p> Conclusion <p>Our findings demonstrate that favorable surgical outcomes for EHBO are achievable even in resource-constrained environments. However, further mitigating postoperative morbidity requires targeted perioperative optimization of high-risk patients, specifically those presenting with prolonged jaundice (&gt; 8 weeks), preoperative cholangitis, poor ECOG performance status, hypoalbuminemia, and malignant biliary obstruction (MBO). Consequently, implementing systematic risk stratification and addressing these key clinical predictors are imperative to minimize complications and optimize patient outcomes.</p> Trial registration <p>Not applicable.</p>