<p>Preserved ratio impaired spirometry (PRISm) is associated with increased morbidity and mortality. However, the impact of PRISm on the postoperative outcomes of non-small cell lung cancer (NSCLC) surgery remains poorly understood. We retrospectively analyzed data of 834 patients with NSCLC from the prospective CATCH-LUNG cohort who underwent curative lung resection between March 2016 and December 2020. The patients were categorized into four groups: normal, PRISm, mild obstructive lung disease (OLD), and moderate OLD. The primary outcomes were postoperative pulmonary complications (PPCs) and cardiac complications (PCCs) that occurred within 30 days post-surgery. The incidences of PPCs and PCCs were significantly higher in the PRISm group (PPC: 11.5%; PCC: 16.4%) than in the normal lung function group (PPC: 3.3%; PCC: 4.6%). Patients with PRISm had adjusted RRs of 2.62 (95% CI: 1.10–6.23) for PPCs and 2.67 (95% CI: 1.42–4.99) for PCCs. The adjusted RRs for PPCs were 2.32 in mild OLD and 3.25 in moderate OLD, whereas those for PCCs were 1.94 in mild OLD and 2.32 in moderate OLD. Notably, among patients with PRISm, those with low FVC (&lt;80% predicted) had markedly higher risks of PPCs (adjusted RR = 3.41; 95% CI: 1.22–9.54) and PCCs (adjusted RR = 3.31; 95% CI: 1.74–6.31) compared to those with normal FVC. PRISm, like chronic obstructive pulmonary disease, substantially increases the risk of postoperative complications of NSCLC surgery and should be recognized as an important clinical category.</p>