Objective To develop a scientific and practical risk assessment system for airway obstruction in elderly orthopedic patients and to identify the high-risk patient as early as possible. Methods The draft version of risk assessment system was formulated after literature retrieval and group discussion, then two rounds of expert consultation were conducted to determine the final version of the indicators.The indicators were validated in 186 elderly orthopedic patients. Results The risk assessment system included 10 indicators:age, consciousness, sputum expectoration, sputum viscosity, pain severity, feasible body position, surgical (injury) site, anesthesia method, basic disease and high-risk factors. Importance of the indicator scored 4-5 points, with the coefficient of variation ranging from 0 to 0.17.Among 186 patients, 4 patients developed airway obstruction (1 at grade 2 risk, 2 at grade 3 risk, and 1 at grade 4 risk). Conclusion The risk assessment system for airway obstruction in elderly orthopedic patients is scientific, reliable and practical, which can achieve early identification of high-risk patient and reduce the incidence of airway obstruction.