Abstract: Objective: To investigate the application of combined spinal and epidural anesthesia and general anesthesia in elderly patients with femoral neck fractures and the impact on the incidence of pulmonary infection. METHODS: A total of 62 elderly patients with femoral neck fractures who were seen at our hospital from July 2016 to May 2017 were randomly selected and divided into experimental group (31 cases) and control group (31 cases). All patients underwent surgical treatment of femoral neck fractures. The control group received general anesthesia, while the experimental group received combined spinal epidural anesthesia. The effects of different anesthetic methods on prognosis and pulmonary infection were compared. Results: The incidence of hypotension, bradycardia, hypoxia and other adverse reactions in the experimental group during the anesthesia was significantly lower than that in the control group. The data were significantly different (P<0.05); the time of onset of anesthesia and the time of recovery after surgery were compared between the two groups. The experimental group was significantly shorter than the control group (P<0.05); the number of patients with postoperative restlessness in the experimental group was also significantly less than the control group (P<0.05); of the 62 elderly patients undergoing femoral neck fracture surgery, there were 30 cases. A total of 40 strains of pathogenic bacteria were detected in the pathogens of lung infections in 30 patients with pulmonary infections. Among them, 29 strains (72.50%) were gram-negative bacteria, 9 strains (22.50%) were Gram-positive bacteria, and 2 strains were fungi (5.00 %). Analysis of Gram-positive bacteria is the main pathogenic bacteria causing postoperative pulmonary infection in elderly patients with femoral neck fractures. Conclusion: Pulmonary infection is one of the most serious postoperative complications in elderly patients with femoral neck fractures. Early detection of pathogens and drug susceptibility testing are carried out. The use of rational antimicrobial therapy can effectively improve the prognosis of patients and reduce mortality.