To evaluate the risks associated with gynecologic surgery in elderly women, the authors reviewed the medical charts of all patients 80 years of age and older (n = 62) who had undergone gynecologic surgery at their institution between January 1995 and September 2000. The women ranged in age from 80 to 94 years. Of the total 77 procedures performed (10 patients had more than 1 procedure), 49 were major and 28 were minor. Cancer or suspected cancer was the indication for surgery in 58 patients. Forty-one patients underwent some type of hysterectomy, including 36 abdominal procedures, 3 vaginal hysterectomies, and 2 laparoscopically assisted vaginal hysterectomies. In all, there were 34 laparotomies, 19 vaginal operations, and 24 vulvar procedures. Major surgical cases had a mean operating time of 151 minutes and minor procedures had a mean 30 minutes of operating time. Average blood losses were 269 mL in major cases and 45 mL in minor cases. General anesthesia was used for 74 of the 77 surgeries. Average times for anesthesia were 189 minutes in major cases and 56 minutes in minor cases. Most patients had other medical conditions; the average number of concurrent illnesses was 3.86. The most common were hypertension (59%), arthritis (40%), and diabetes (9%). Over half of the patients (59%) who underwent minor procedures were discharged the same day. The average length of hospital stay for the remaining women was 3.6 days. Eleven patients (14%) had a perioperative complication. Combativeness and disorientation with sundowning developed in 2 patients. Other complications included 1 patient each with fever, ileus, oliguria, elevated blood pressure, congestive heart failure/pneumonia, atrial fibrillation, acute myocardial infarction, and pneumonia. In addition, 1 patient was bleeding from the incision site in the recovery room and was taken to the operating room for exploration and reclosure of the incision.