Background: Appendicitis is a condition characterized by inflammation of the vermiform appendix. It is classified as a surgical emergency and many cases require removal of the inflamed appendix either by laparotomy or laparoscopy. If left untreated, mortality is high, mainly because of rupture leading to peritonitis and shock. In most parts of the world, including Ethiopia, Acute appendicitis is one of the major cause for which many patients undergo surgical intervention. However, there was no adequate study about management outcome of acute appendicitis in Hawassa in particular. Objectives: The aim of the study was to determine the management outcome of acute appendicitis and its associated factors in Hawassa University Comprehensive and Specialized Hospital (HUCSH), South Ethiopia. Methods: A three-year retrospective document review of all cases (336) of acute appendicitis surgically managed at HUCSH from September 2014- August 2017 G.C was undertaken. Data was abstracted from patients’- cards and log books using structured checklist by trained data collectors. The result was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20 by using bivariate and multivariate logistic regression. Finally the data was described and presented using narrative text, tables and graphs. Result: Two hundred and thirty three (69.3%) of study subjects were male and one hundred three (30.7%) were females (male-to-female ratio of 2.3:1). All patients (100%) presented with abdominal pain. The Average length of hospital stay was 4 days. Seventeen (5.1%) of patients has unfavorable outcome. Death of patients due to appendicitis was 2(0.6%) during the three years study period. Patients who come from rural area (P.Value=0.014, AOR=4.13; 95% CI (1.34- 12.76), age less than 30 years (P.Value=0.009, AOR=4.27; 95% CI (1.43-12.79) and patients for whom peritoneal lavage done (P.Value=0.043, AOR=6.35; 95%CI (1.10-37.96) has statistically significant association with unfavorable management outcomes of acute appendicitis. Conclusion In this study, about 5% of surgically managed acute appendicitis patients had unfavorable outcome. Postoperative wound infection accounted for more than eight in ten of the unfavourable outcomes. Age greater than 30 years, rural residence and undergoing peritoneal lavage procedure were found to significantly increase the odds of unfavorable outcome among surgically managed Acute Appendicitis patients