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Postoperative pulmonary complications are an important cause of postoperative morbidity and mortality after major noncardiac surgery. The reported frequency varies widely as defined by the definition of postoperative pulmonary complication, the patient population, and the type of surgery. The most common complications, namely, postoperative pneumonia and respiratory failure are strongly associated with the type of surgical procedure and other procedure specific factors. Among the patient related risk factors, age and the American Society of Anesthesiology class stratify the postoperative risk most powerfully. Preoperative spirometry may not offer incremental predictive benefit except in certain types of surgery. Potential strategies to reduce the postoperative complications include risk stratification for pneumonia and respiratory failure, adequate postoperative analgesia, short-acting neuromuscular blockade, postoperative lung expansion modalities, selective use of postoperative nasogastric decompression, laparoscopic surgery where possible, and nutrition.