Background: Postoperative complications remain a major cause of morbidity and mortality following emergency digestive surgery, particularly in low- and middle-income countries where delayed presentation and limited healthcare resources are common. Evidence regarding predictors of postoperative complications in sub-Saharan Africa remains scarce. This study aimed to determine the incidence, pattern, severity, and predictors of postoperative complications following emergency digestive surgery in three tertiary hospitals in Cameroon. Methods: We conducted a multicenter retrospective analytical study in three referral hospitals in Douala, Cameroon, including the Douala General Hospital, Douala Laquintinie Hospital, and Deido District Hospital. Adult patients undergoing emergency digestive surgery between January 2018 and December 2023 were included. Demographic, clinical, operative, and postoperative data were collected. Complications were graded according to the Clavien–Dindo classification. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of postoperative complications. Results: We analyzed 1,102 patients undergoing emergency digestive surgery, among whom 361 developed postoperative complications (32.8%). Surgical site infection was the most frequent complication (32.6%). Most complications were classified as minor (73%) according to Clavien–Dindo grading. The overall mortality rate was 7.2%. Multivariate analysis identified age between 50 and 60 years, ASA III status, and Altemeier class III as independent predictors of postoperative complications. Conclusion: Approximately one-third of patients undergoing emergency digestive surgery developed postoperative complications. Advanced age, poor preoperative physical status, and contaminated surgical wounds significantly increased the risk of adverse postoperative outcomes. Early identification of high-risk patients may improve perioperative management and reduce po