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Introduction: Peptic ulcer perforation is the most common complication in peptic ulcer disease and can lead to serious complications and mortality; however, despite the widespread use of antisecretory agents and eradication of Helicobacter pylori, the incidence of peptic ulcer perforation remains largely unchanged. This study aimed to evaluate the risk factors for perioperative morbidity and mortality in patients with peptic ulcer perforation. Methods: This was a prospective, observational study involving patients with perforated peptic ulcer disease admitted to the Al-Basra Teaching Hospital from January 2017 to December 2019. A total of 100 patients were followed for 4 weeks. Patients’ demographic data, history of chronic diseases, American Society of Anesthesiologist (ASA) score, nonsteroidal anti-inflammatory drug (NSAID) and steroid use, duration before surgery, preoperative shock status, previous symptoms of peptic ulcer disease, smoking habits, and fasting status were evaluated, and significant correlations with postoperative complications were analyzed statistically. Results: A total of 100 patients aged 16–87 years were included in the study, and the male-to- female ratio was 3:1. Sixty-seven (67%) patients underwent surgery within 12 h after admission, 41% of patients had a history of chronic disease, 54% of patients had an ASA score of 1, 57% of patients were smokers, 45% of patients reported previous peptic ulcer symptoms, and 22% of patients had preoperative shock status. Thirty-seven (37%) patients developed postoperative complications, and 8% of patients died. Conclusion: This study confirmed that advanced age, a high ASA score, preoperative shock, comorbidities, and delayed presentation before surgery were all risk factors for postoperative complications and mortality in patients with perforated peptic ulcer disease. Habitual smoking, fasting status, and NSAID and steroid use were not correlated with mortality.