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The overall safety of surgical lung biopsy in patients with idiopathic interstitial pneumonia (IIP) remains controversial. This study was performed to investigate the mortality and complication rate and identify the risk factors for surgical lung biopsy in patients with IIP.A total of 200 patients with IIP who underwent surgical lung biopsy at the Asan Medical Center, Korea, from April 1990 to August 2003, were enrolled. Complications and mortality were analyzed retrospectively.(1) The mortality rate 30 days after the surgical lung biopsy was 4.3%, which was significantly higher than the control group. Biopsy performed at the time of acute exacerbation (AE) resulted in higher 30-day mortality (28.6%) compared to non-AE (3.0%; p≪ 0.05). AE was followed by biopsy itself in three cases. (2) Univariate analysis indicated that lower FVC, lower DLCO, and presence of AE were significant risk factors for 30-day mortality (p ≪ 0.05). However, multivariate analysis revealed that only AE (OR: 11.334, 95% CI: 1.727-74.365, p = 0.011) was an independent risk factor. (3) The patients with low DLCO (≪50% predicted) had higher mortality and complication rate than high DLCO group.Our data suggested that the presence of acute exacerbation at the time of biopsy and lower DLCO were predictors of higher mortality after the surgical lung biopsy.