BACKGROUND: World Health Organization recommends in patient therapeutic feeding program as a standard treatment protocol for the management of complicated severe acute malnutrition. This program has been decentralized to public hospitals in Ethiopia. Early recovery is a performance indicator for severe acute malnourished children for the therapeutic feeding. OBJECTIVE: The aim of the study was to assess time to recovery and its predictors among children aged 6-59 months admitted with severe acute malnutrition to inpatient therapeutic feeding centers at hospitals in west Shoa zone, Ethiopia. METHODS: Institution based retrospective cohort study was conducted on 428 children aged 6 to 59 months admitted with Severe Acute malnutrition cases at selected hospitals in West Shewa zone from January 1, 2017 to December 30, 2021. A total of 428 charts were selected using a systematic random sampling method and 395 of them were used for the final analysis. Kaplan-Meier estimates and survival curve were used to estimate the survival time, log-rank test was used compare survival time between groups of categorical variables, and Cox-proportional hazard model was used to identify significant predictor of the time to recovery. P value <
0.05 was considered statistically significant. RESULTS: The nutritional of recovery rate was 81.27% (95% CI
77.09-84.83) with a median nutritional recovery time of 15 days (IQR
10). The predictors of time to recovery were having HIV (AHR = 0.31, 95% CI, 0.14-0.66), Tuberculosis (AHR = 0.25, 95% CI, 0.16-0.38), not breast feeding until 24 months (AHR = 0.29, 95% CI, 0.22-0.41), partially vaccinated for age (AHR = 0.43, 95% CI, 0.31-0.61), Admitted during production season (AHR = 0.49, 95% CI, 0.37-0.67) and not took deworming (AHR = 0.60, 95% CI, 0.48-0.75) were associated with longer periods of nutritional recovery time. CONCLUSION AND RECOMMENDATIONS: Both percentage of recovery and the recovery time were within the acceptable minimum standards. But special attention has to be given to children who having HIV, Tuberculosis, breast feeding less than 24 months, partially vaccinated for their age, children admitted during production season and not supplementing with deworming during inpatient management. The health workers with different stages of health administer must increase the awareness of breastfeeding, fully vaccination and ways of preventing communicable disease.