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Background and Aims Postoperative pulmonary complications remain a significant problem for elderly patients undergoing hip surgery under general anesthesia. The aim of this study was to evaluate the predictive preoperative test associated with postoperative pulmonary complications in elderly patients undergoing hip surgery under general anesthesiaMethods A retrospective observational study was performed of patients aged 60 years or older undergoing hip surgery under general anesthesia at a tertiary care hospital from January 2018 to December 2022. The data collected included demographic information, laboratory tests, pulmonary function tests, pulmonary imaging tests including CT and X-ray, results of preoperative consultation with a pulmonologist, and postoperative outcomes. Afterwards, the relationship between preoperative tests and the occurrence of postoperative complications were analyzed through regression analysis.Results 544 patients were divided into two groups: those that developed pulmonary complications (pulmonary complications group, PCG, n= 236) and those that did not (control group, CG, n= 308). The PCG was significantly older, included more emergency cases, and had significantly more patients with cardiovascular and renal diseases than the CG. In preoperative consultation with a pulmonologist, there were significantly more moderate to high risk patients in the PCG. Laboratory tests showed significantly higher WBC and bilirubin levels, and lower aPTT in the PCG. ABGAs1, PFTs2, and operation data showed no difference. A multivariate logistic regression analysis revealed that moderate or higher risk given in preoperative consultations was associated with a 204% increase in pulmonary complications [odds ratio (OR): 2.045, P = 0.012]. Increased WBC counts (OR: 1.000), decreased aPTT (OR: 0.932), history of cardiovascular disease (OR: 0.281), were also associated with pulmonary complications (P = 0.001).Conclusions In conclusion, preoperative pulmonary consultation with a pulmonologist of a moderate or higher risk was the best predictor associated with postoperative pulmonary complication in elderly patients undergoing hip surgery under general anesthesia