A three-year retrospective analysis was undertaken of all surgical admissions to Tikur Anbessa Hospital (TAH) between September 1994 and August 1997. There was a total of 5,353 surgical admissions of which 3,968 (74.1%) were elective cases. The overall male to female ratio was 1.7:l. Gastrointestinal and genitourinary conditions accounted for 62% of elective cases, while for emergencies, gastrointestinal and neuro-surgical patients constituted 75.8% of admissions. The overall mortality was 8%, being higher for emergencies (21.1%) than for elective surgery (3.4%) Gastrointestinal (GI) and neurosurgical conditions accounted for 71.2% of all deaths. Neurosurgical emergencies had the highest mortality rate (36.8%). The admission pattern revealed that many of the patients had conditions that could have been treated at the secondary level hospitals and that some causes death were preventable.