Background: Preoperative nutritional status is a critical factor influencing postoperative outcomes in elective abdominal surgery. This study aimed to evaluate the association between preoperative nutritional status and postoperative complications in patients undergoing elective abdominal surgery at a tertiary care center in North-East India. Methods: This cross-sectional study included 393 patients undergoing elective abdominal surgery. Preoperative nutritional status was assessed using Body Mass Index (BMI) and Subjective Global Assessment (SGA). Postoperative outcomes, including wound complications and length of hospital stay, were evaluated. Results: The mean age of participants was 41.1 ± 10.6 years, with 62.3% females. Preoperatively, 4.6% of patients were undernourished (BMI <18.5 kg/m²), and 2.0% were severely malnourished (SGA 'C'). Postoperative wound complications occurred in 16.5% of patients. A significant association was found between preoperative nutritional status and wound complications (p<0.001). Among undernourished patients, 88.9% experienced complications, compared to 5.1% in the normal BMI group. All severely malnourished patients (SGA 'C') developed complications. The mean length of hospital stay was significantly longer for malnourished patients (16.7 days for SGA 'C' vs 4.5 days for SGA 'A', p<0.001). Conclusion: Preoperative malnutrition is strongly associated with increased postoperative wound complications and prolonged hospital stays in patients undergoing elective abdominal surgery. These findings emphasize the importance of preoperative nutritional assessment and intervention to optimize surgical outcomes.