Objective To construct a multi-dimensional evaluation system for physical function and functional rehabilitation of elderly patients with lung cancer during perioperative period based on the modified Delphi method.Methods From December 2024 to April 2025, based on literature search and group research, a multi-dimensional evaluation indicator system for perioperative physical function and functional rehabilitation of elderly patients with lung cancer was initially constructed, and 13 experts in the field of elderly lung cancer treatment and perioperative rehabilitation were selected. Based on the modified Delphi method, two rounds of consultation and in-depth communication were conducted with experts to objectively evaluate the importance of indicators at all levels and finally appropriate indicators were selected. Results Through two rounds of expert consultation, a multi-dimensional comprehensive evaluation system was established, including 6 primary indicators (general situation and disease characteristics; physical fitness; pulmonary function; respiratory muscle function; balance function; activities of daily living, quality of life and emotional and psychological conditions) and 24 secondary indicators. The response rate of the two rounds of consultation questionnaires reached 100%, the coefficient of expert authority was 0.93±0.05, and the Kendall’s coefficient of concordance of the primary and secondary indicators were 0.391 and 0.187, respectively (P<0.05).ConclusionsThe multi-dimensional perioperative evaluation system of elderly patients with lung cancer constructed based on the modified Delphi method has good rationality and scientificity, which is helpful to comprehensively and multi-dimensionally evaluate the perioperative risk and functional status of elderly patients with lung cancer, and provide guidance and reference for clinical practice.