Perforation peritonitis remains one of the most common surgical emergencies in developing countries and is associated with significant postoperative morbidity and mortality. Early identification of predictors of morbidity helps in risk stratification and improves clinical outcomes. Materials and Methods: A prospective observational study was conducted on 120 patients undergoing emergency laparotomy for perforation peritonitis in a tertiary care center over 18 months. Clinical, laboratory, and intraoperative variables were recorded. Postoperative complications were graded using the Clavien-Dindo classification. Statistical analysis was performed to identify independent predictors of morbidity. Results Postoperative morbidity was observed in 54 (45%) patients. Advanced age (>60 years), delay in presentation (>24 hours), hypoalbuminemia (<3.0 g/dL), septic shock at admission, and high Mannheim Peritonitis Index (MPI >26) were significantly associated with increased morbidity (p<0.05). Multivariate logistic regression showed hypoalbuminemia, septic shock, and MPI score as independent predictors. Conclusion Preoperative nutritional status, systemic sepsis, and severity scoring systems are strong predictors of postoperative morbidity in perforation peritonitis. Early recognition and aggressive management may reduce complications.