Background: Postoperative complications (POCs) after gastrointestinal surgery are a major cause of morbidity and mortality, especially in low-resource settings. This study assessed their incidence, risk factors, and outcomes at a tertiary hospital in Burundi. Materials and Methods: A prospective observational cohort study was conducted over 12 months (October 2024-September 2025) at Kamenge University Teaching Hospital, Bujumbura. All patients undergoing gastrointestinal surgery were included and monitored for POCs during hospitalization. Data were collected using a standardized form and analyzed with SPSS version 26. Logistic regression identified independent risk factors. Results: Of 416 patients, 71 developed POCs, yielding an incidence of 17.06%. Mean age was 28.2 ± 23.9 years. Among the 71 patients who developed postoperative complications, 42 (59.15%) were male, yielding a male-to-female ratio of 1.44. Among these patients, 60 (84.51%) belonged to ASA classes III - IV. Emergency surgery accounted for 83.09% of complicated cases. Infectious complications predominated (43.66%), with surgical site infection most frequent. Mortality among patients with complications was 31.00%. Multivariate analysis identified emergency surgery (OR = 3.5; 95% CI: 1.8 - 6.7; p = 0.001), ASA III - V (OR = 2.8; 95% CI: 1.3 - 5.9; p = 0.006), operative duration > 120 minutes (OR = 2.2; 95% CI: 1.1 - 4.3; p = 0.02), contaminated/dirty wounds (OR = 3.1; 95% CI: 1.5 - 6.2; p = 0.002), and prolonged antibiotic use (OR = 1.9; 95% CI: 1.0 - 3.5; p = 0.04) as independent predictors. Conclusion: POCs remain frequent and severe in this setting, with high mortality. Emergency surgery, poor preoperative condition, prolonged operative time, and inappropriate antibiotic use are key modifiable risk factors. These findings should be interpreted as associations rather than causal relationships. Prospective studies are required to confirm these observations and identify modifiable perioperative interventions to reduce postoperative complications.
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