Purpose <p>Acute mesenteric ischemia (AMI) remains a therapeutic challenge, with high mortality and limited data on long-term prognosis. This study aimed to describe postoperative and survival outcomes following surgery for AMI and identify factors associated with in-hospital mortality.</p> Methods <p>A retrospective study was conducted on adult patients (&gt; 18 years) undergoing surgery for AMI between January 2010 and August 2024 at two tertiary centers. Demographic, clinical, and operative data were collected. The primary outcome described survival patterns following discharge. Secondary outcomes included postoperative outcomes and variables associated with in-hospital mortality.</p> Results <p>Among 104 patients with AMI, 24 (23.1%) underwent arterial revascularization (22 with concurrent bowel resections) and 8 (7.7%) had non-therapeutic laparotomies. The median number of surgical explorations was 2 per patient during the index admission. In-hospital mortality was 50%, with most occurring in the first postoperative week. Univariate analysis showed non-survivors were significantly older, exhibited higher Charlson Comorbidity Index scores, and higher serum creatinine levels. Additionally, non-survivors more frequently demonstrated pneumatosis intestinalis on CT scan, had a longer bowel segment resected and were more likely to have arterial thrombosis as the underlying etiology. Five-year survival post-discharge was 74.8%, with most deaths occurring within the first 12 months. Sepsis was the leading cause of death post-discharge, followed by cardiovascular disease.</p> Conclusion <p>In-hospital mortality among patients with AMI is substantial and is associated with advanced age, increased comorbidity burden, arterial etiology, and extensive bowel resection. Survival beyond hospital discharge carries a reasonable prognosis.</p>