OBJECTIVE To report perioperative morbidity and mortality rates in elderly women who underwent major gynecologic surgery. METHODS The charts of 110 women between 80 and 91 years of age who underwent major gynecologic surgery between July 1995 and May 2003 were retrospectively reviewed. RESULTS The mean age was 83.1 years. Forty-nine procedures (44.1%) were performed for cancer, 32 (28.8%) for a mass and 23 (20.7%) for pelvic organ prolapse or urinary incontinence. Sixty-nine (62.7%) procedures were performed abdominally, 36 (32.4%) vaginally and 5 (4.5%) laparoscopically. Fifty (44.6%) patients experienced a postoperative complication, and 9 (8.1%) experienced a major one. Major complications included serious morbidity, in 5 (4.5%) patients, and mortality, in 4 (3.6%). Advanced age (> 85 years) was not associated with any of the outcomes of interest, while prior surgical history was significantly associated with a decreased hospital stay (p < 0.001). Increased hospital stay was associated with a moderate or severe medical history (p < 0.05) and laparotomy/laparoscopy vs. vaginal surgery (p < 0.01). CONCLUSIONS Postoperative complications occurred frequently among women > 80 years of age who underwent gynecologic surgery. The increased perioperative morbidity in the elderly should be considered when performing surgery on women in that age group.