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Background Emergency abdominal surgeries (EASs) in children are often necessary to address life-threatening congenital and acquired conditions. This study aimed to determine short-term outcomes and predictors of in-hospital mortality after EAS in children at Mbarara Regional Referral Hospital (MRRH), South-Western Uganda.Methods This prospective study was conducted from June to September 2024 and included children aged 0–17 years who underwent EAS at MRRH. Outcomes measured were 30-day in-hospital mortality, complications, and length of hospital stay. Overall survival after EAS was plotted using Kaplan-Meier curves. Cox regression analysis was used to determine predictors of in-hospital mortality after EAS.Results The 30-day mortality rate for all pediatric abdominal surgery was 152 per 10 000 person-days of hospitalization. Among 96children who required EAS at MRRH, the risk of death was significantly increased in those who had hypoxemia (adjusted hazard ratio (aHR) 12.4, p=0.011) and hypokalemia (aHR 5.02, p=0.044). Forty-one patients (42.7%) developed postoperative complications, the most common being surgical site infection (14.58%) and pneumonia (5.2%).Conclusion The 30-day mortality rate after pediatric EAS in our setting is high and children who present with hypokalemia and hypoxemia are at increased risk of mortality after EAS.