Objective To explore the preventive effect of graded nursing based on Caprini risk assessment scale on perioperative venous thromboembolism (VTE) in elderly lung cancer patients. Methods A total of 228 elderly patients who underwent thoracoscopic radical resection of lung cancer were divided into a control group of 113 and an intervention group of 115 according to their admission time, receiving either routine nursing or graded nursing based on the Caprini score for risk assessment of VTE. The incidence of VTE, maximum width of thrombus in vertical vessel wall, chest tube indwelling time, length of hospital stay and hospitalization expenses were compared between the two groups. Results The incidence of VTE was 4.35% in the intervention group and 11.50% in the control group, showing significant difference between them (P<0.05). The maximum width of thrombus in vertical vessel wall, chest tube indwelling time, hospitalization time and hospitalization expenses in the intervention were significantly lower than those in the control group (P<0.05 for all). Conclusion Implementing graded nursing based on the Caprini risk assessment scale can effectively reduce the risk of perioperative VTE in elderly patients with lung cancer and enhance postoperative recovery.