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Objective This study aimed to find the incidence and predictors of postoperative haemodynamic instability among adult surgical patients in the postanaesthesia care unit (PACU).Study design A multicentre prospective observational study was conducted from 1 June to 30 September 2024.Setting The study was conducted at three hospitals in the South Gondar Zone, north-west Ethiopia.Participants The study included 404 elective surgical patients undergoing surgery who were in the PACU. All adult patients who were fit, stable and underwent elective surgery under anaesthesia and were admitted to the PACU for monitoring and stabilisation were included in the study. Patients who were directly admitted to an intensive care unit or ward after an operation and those who refused to give consent were excluded from the study.Outcome measures The study investigates the incidence and predictors of immediate postoperative haemodynamic instability in adult surgical patients.Result The incidence of postoperative haemodynamic instability in the PACU was 47.8% (95% CI 43.1% to 52.5%). Multivariable logistic regression analysis shows that American Society of Anesthesiologists class III patients (adjusted OR (AOR): 3.04, 95% CI 1.48 to 6.25), patients with preoperative anxiety (AOR: 2.9, 95% CI 1.73 to 4.78), preoperative use of beta-blocker medication (AOR: 1.9, 95% CI 1.11 to 3.32), patients who experienced intraoperative haemodynamic instability (AOR: 1.8, 95% CI 1.2 to 3.14) and patients with a procedure lasting more than 4 hours (AOR: 3.7, 95% CI 3.26 to 9.67) were significantly associated with haemodynamic instability.Conclusion The incidence of postoperative haemodynamic instability in this study was high. Our findings highlight the urgent need for hospital quality improvement initiatives and healthcare professionals assigned to the PACU should monitor the patients continuously. We also recommend that future researchers monitor the patients for 24 hours.