Background The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia.Methods The retrospective study consecutively included elderly patients (>= 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs.Results 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA >= III (P = 0.006, 95% CI: 1.230 similar to 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 similar to 4.867), smoking (P = 0.027, 95% CI: 1.072 similar to 3.194) and COPD (P = 0.015, 95% CI: 1.332 similar to 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients.Conclusion Risk factors for PPCs are ASA >= III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts.