Background: Older adult patients are more prone to long-term complications from coronavirus disease 2019 (COVID-19) and are generally more vulnerable during lung surgery compared to younger individuals. This study aimed to determine whether a past COVID-19 infection elevates surgical difficulty and risk for older adult patients with non-small cell lung cancer (NSCLC), identify high-risk post-COVID-19 subgroups, and preoperatively predict surgical difficulty and risk. Methods: Patients with clinical T1-3N1-2M0 NSCLC, aged >= 65 years, and with a history of COVID-19 (PCOV group) or without one (NCOV group) who underwent curative surgery at seven tertiary health care institutions in China between 2021 and 2024 were retrospectively included. The surgical difficulty and risk were measured according to the incidence of conversion and severe postoperative complications (Clavien Dindo grade >= III), respectively. Propensity-score matching (PSM) was used to mitigate patient selection bias. Prediction models were developed to preoperatively forecast the risk of conversion and severe complications. Results: PSM of the 22,101 included cases generated 7330 cases per group with well-balanced baseline characteristics. The two groups had comparable conversion rates (PCOV: 6.5% vs. NCOV: 5.9%; P=0.17), although the PCOV group had a longer median surgical duration [89.0 min, interquartile range (IQR): 70.0-103.5 min] than did the NCOV group (99.0 min, IQR: 85.5-111.0 min) (P<0.001) and a longer time to postoperative recovery. Further stratification analysis revealed that a history of COVID-19 infection significantly increased conversion risks in heavy smokers [odds ratio (OR) =1.283; 95% confidence interval (95% CI): 1.040-1.687]. Additionally, the two groups had similar severe complication incidences (PCOV: 6.6% vs. NCOV: 6.0%; P=0.13), while the PCOV group had a higher incidence of overall complications (20.2% vs. 18.7%; P=0.03) and respiratory complications. Stratified analysis indicated that previous infection with COVID-19 significantly increased the risk of severe complications in patients aged >= 75 years (OR =1.312; 95% CI: 1.013-1.799) and heavy smokers (OR =1.297; 95% CI: 1.022-1.639). Finally, the nomograms developed to predict the surgical difficulty and risk for patients with a history of COVID-19 and for high-risk populations demonstrated good performance. Conclusions: Past COVID-19 infection does not significantly increase surgical difficulty or risk for older adult patients with NSCLC. However, heavy smokers and those aged >= 75 years face elevated surgical risks following COVID-19 infection. The proposed preoperative prediction models can effectively forecast surgical difficulties and risks for older adult patients with NSCLC.