Background: The aim of this study was to evaluate the incidence, risk factors, and clinical outcomes associated with postoperative pulmonary complications (PPCs) following emergency abdominal surgery.Materials and Methods: This prospective observational study was conducted at a tertiary care hospital involving 90 patients undergoing emergency abdominal surgery. Preoperative data, including demographic information, comorbidities, smoking history, and pulmonary function tests (spirometry and arterial blood gases), were collected. Postoperative complications, including atelectasis, pneumonia, ARDS, pulmonary embolism, and respiratory failure, were monitored. Results: A total of 35.56% of patients developed PPCs, with atelectasis being the most common (13.33%). Smoking history, older age, and comorbidities like hypertension and diabetes were significantly associated with the development of PPCs. Abnormal preoperative spirometry results were linked to a higher risk of PPCs (p = 0.034). The need for respiratory support was significantly higher in PPC patients, with 16.67% requiring supplemental oxygen and 5.56% needing mechanical ventilation.Conclusion: This study identifies key risk factors for PPCs in emergency abdominal surgery patients, including older age, smoking, and preoperative pulmonary dysfunction. These findings suggest that careful preoperative assessment and management of comorbidities and pulmonary function may reduce the incidence of PPCs and improve patient outcomes.