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Objective: To assess which factors predict in-hospital mortality after emergency surgery for acute perforated diverticulitis., Design: Multicenter retrospective study., Method: From 1995-2005 a total of 291 patients underwent surgery to treat perforated diverticulitis in five teaching hospitals in Rotterdam, the Netherlands. The relation to postoperative mortality of patient-related risk factors such as age, gender and classification according to the American Society of Anesthesiologists (ASA); disease severity factors such as Hinchey score and Mannheim peritonitis index (MPI); surgery-related risk factors, such as type of surgery, e.g. Hartmann’s procedure (HP) or resection with primary anastomosis; surgeon, and time of operation were evaluated using multivariate analysis., Results: The total postoperative in-hospital mortality was 29%. HP was performed 211 times and primary anastomosis was performed 75 times. HP was significantly more frequently performed in patients with higher values of age, ASA, Hinchey and MPI (all: p < 0.01). Multiple logistic regression analysis showed that age, ASA classification, Hinchey score, MPI and the absence of a specialist gastrointestinal surgeon during surgery, were important prognostic factors of mortality. Surgical technique was not related to postoperative mortality (adjusted odds ratio for mortality (HP versus primary anastomosis): 1.3; 95% CI: 0.6-2.9; p = 0.54)., Conclusion: The type of surgery did not appear to be a risk factor for high postoperative mortality. As well as patient-related risk factors, including age, ASA and severity of disease scores, such as Hinchey score and MPI, the absence of a specialist gastrointestinal surgeon during surgery was found to be a factor associated with high mortality risk.