Purpose <p>Despite advancements in surgical patient care, postoperative pulmonary complications (PPCs) following emergency abdominal surgery remain common and are linked to increased morbidity, mortality, and healthcare costs. This study aims to identify the incidence and risk factors of PPCs following major emergency abdominal surgery.</p> Methods <p>This is a single-center observational study including patients undergoing major emergency abdominal surgery between January 1, 2021, and December 31, 2023, collecting pre-, intra-, and postoperative variables. The primary outcome was the occurrence of PPCs, and the secondary outcomes were risk factors for PPCs and 30-day mortality rates following PPCs. Multivariable logistic regression was used to identify perioperative risk factors associated with PPCs. The same analysis was used on a subgroup of patients with ‘severe’ PPCs.</p> Results <p>Of 1080 patients included in the study, 431 (39.9%) had at least one PPC, and 150 (13.9%) had at least one ‘severe’ PPC. Multivariable logistic regression identified several risk factors for developing PPCs: an increased ARISCAT score, a history of pulmonary disease, hypertension, a history of cerebral disease, increased Clinical Frailty Scale, preoperative admission to the intensive care unit, a CDC grade IV contaminated wound, intraoperative findings of perforated stomach or duodenal ulcer, need for subsequent reoperations, and protracted postoperative ileus. Patients with PPCs had a 30-day mortality rate of 21.0%, while those with ‘severe’ PPCs had a 30-day mortality rate of 46.3%.</p> Conclusion <p>Several independent risk factors, beyond those already established, were associated with an increased risk of PPCs.</p>