BACKGROUND:: With advances in medical care, patients with cystic fibrosis are more commonly living into adulthood yet there are limited data describing the need for gastrointestinal surgery and its outcomes in adult cystic fibrosis patients. OBJECTIVE:: We aim to use a national administrative database to evaluate trends in abdominal gastrointestinal surgery and associated postoperative outcomes among adult cystic fibrosis patients. DESIGN:: This was a national retrospective cohort study. SETTING:: A national all payor administrative database from 2000-2014 was used. PATIENTS:: Patients included all adult (age ≥18) patients with cystic fibrosis undergoing abdominal gastrointestinal surgery. MAIN OUTCOME MEASURES:: The primary outcome was trend over time in number of surgical admissions. Secondary outcomes included morbidity and mortality by procedure type. RESULTS:: We identified 3,075 admissions for abdominal surgery of which 28% were elective. Major GI surgical procedures increased over the study period (p<0.01) while appendectomy and cholecystectomy did not demonstrate a clear trend (p=0.90). The most common procedure performed was cholecystectomy (n=1,280; 42%). The most common major surgery was segmental colectomy (n=535; 18%). Obstruction was the most common surgical indication (n=780; 26%). For major surgery, in-hospital mortality was 6%, morbidity 37% and mean length of stay 15.9 days (SE 1.2). LIMITATIONS:: The study is limited by a lack of granular physiologic and clinical data within the administrative data source. CONCLUSIONS:: Major surgical admissions for adult patients with cystic fibrosis are increasing with the majority being non-elective. Major surgery is associated with significant morbidity, mortality and prolonged length of hospital stay. These findings may inform perioperative risk for adult patients with cystic fibrosis in need of gastrointestinal surgery. See Video Abstract at http://links.lww.com/DCR/B850.