Mekonnen HussenAlemu TsionBelete Zenbaba2021-12-312023-11-062021-12-312023-11-062021-06http://etd.aau.edu.et/handle/123456789/29452Background: Delay is defined as considerable wait time for staffs, patients, and waste of resources. It can occur during each stage of the perioperative pathway and can be the result of patient and/or hospital related reasons and has negative impact on patient and health care system. Objectives: To determine 1st case surgical delay of elective surgery and its associated factors at Tikur Anbessa specialized hospital, Addis Ababa,Ethiopia. Methodology: Hospital based cross-sectional study was conducted at Tikur Anbessa Specialized Hospital surgical specialties from 5 Feb, 2021 – 15 March, 2021. Study subjects were selected from daily scheduled elective cases purposively. The delay of surgery was assessed by using the observation checklist and entered in to Epi-data version 3.1 and imported to SPSS version 25.0 for analysis for descriptive statistics. Bivariate and multivariable logistic regression analysis technique was used to analyze the associations between independent variables and dependent variables with P-values < 0.05 were considered statistically significant. Result: The prevalence of surgical delay was 227(91.5%). There was a significant association between patients age [(AOR=3.51) 95%CI(1.78, 14.80)] and lack of patients investigation [(AOR=7.17) 95%CI(3.02, 29.38)] from patient factors, Long time needed to Anesthesia team to prepare patient [(AOR=8.21) 95%CI(1.98, 28.80)] and punctuality of surgeons [(AOR=9.22) 95%CI(1.05, 16.45)] from health care providers factors, and Lack of ICU bed [(AOR=6.19) 95%CI(4.04, 25.49)] and absence of blood for transfusion [(AOR=5.28) 95%CI(2.18, 9.88)] fromhospital factors and first case delay. Conclusion: The prevalence of 1st case delay is high. Patient’s age, lack of patient’s investigation,refusal of patients, long time needed to Anesthesia team to prepare patient, punctuality of surgeons and absence of blood for transfusion were significantly associated with delay of 1 case surgery. Recommendation: Stakeholders should minimize time needed to prepare patient for surgery,responsible and punctual on time, avoid a breakdown in communication or /schedul ingphase of the patient journey and have good planning hospital management to prepare sufficient theatre for avoidance of delay of for surgery and minimization of cancellation of patient out come and theatre inefficiency.en-USSurgical delay, Operation Theater, first case surgery, start time, elective surgeryThesis