Introduction: To date there have been no published studies exploring outcomes of nonagenarians undergoing general surgical operations. Such data is particularly important in the setting of continued national increases in life expectancy.Methods: A single center, retrospective analysis was performed at our institution. General surgical operations performed in nonagenarians from 1998 to 2008 were identified. Two to one controls were generated and matched for procedure and emergency status. Primary outcomes were early (30 day) and late (12 month) mortality. Two sample t-tests were used to compare several independent variables. These included length of stay, duration of operation, ejection fraction, and ASA (American Society of Anesthesiologists) score. Logistic regression was used to analyze associations between select independent variables and the outcomes of interest.Results: During the study period, 544 total procedures were performed in nonagenarians and of these 53(9.7%) were general surgical operations. Mean age of nonagenarians was 91.5 ± 1.76 (range 90 - 97) versus that of controls, 60.8 ± 15.8 (range 30 - 87).The most common operations were colorectal resection 23/53 (43.4%), hernia repair 13/53 (24.5%), exploratory laparotomy/adhesiolysis 6/53 (11.3%), and small bowel resection 5/53 (9.4%). Nonagenarian and control groups were not significantly different with respect to duration of operation, length of stay, and ejection fraction. There was no significant difference in early mortality noted between nonagenarians and controls among all operations, 3/53 (5.6%) vs. 5/106 (4.7%) p=0.7991. There was a trend towards a significant difference in late mortality between nonagenarians and controls among all operations, 13/53 (25.5%) vs. 21/106 (19.8%) p=0.0567. Among nonagenarians with an elective operation (34/53; 64.1%), there was one early mortality (1/34; 2.9%) versus none in controls (0/68; 0%), and four late mortalities (4/32; 12.5%) in nonagenarians versus six (6/68; 8.8%) in controls (p=0.5676). Among nonagenarians with an emergent operation (19/53; 28.8%), there were two early mortalities (2/19; 10.5%) versus five in controls (5/37; 13.2%) (p=0.7489), and nine late mortalities (9/19; 47.4%) in nonagenarians versus ten (10/37; 26.3%) in controls (p=0.0473).Conclusion: General surgical operations in nonagenarians are reasonable, without increased early mortality, length of stay, or operative time. There is a significant difference in late mortality among emergent operations in nonagenarians compared with controls. However, general surgical operations, particularly those which are elective, are not prohibitive in nonagenarians.