Surgical procedures for elderly patients were retrospectively analyzed to evaluate the adequacy of the surgical indication and procedure. Contributing factors for 30 days mortality, hospital death, and postoperative survival were studied in a total of 136 patients 80 years of age and older operated under general anesthesia. Operative mortality rate was 2.2% (3/136). Hospital death occurred in 6.6% (9/136) of the cases. Non-curative operation, preoperative long stay in the hospital, emergency operation, and postoperative complication were defined as significant risk factors for hospital death by a univalent analysis. Stepwise logistic regression analysis demonstrated that preoperative long stay in the hospital and emergency operation were risk factors associated with hospital death. Only postoperative complication was identified as a risk factor for 30 days mortality. One-year and 3-year overall survival rates were 80% and 69%, respectively. There was no significant difference between patients aged 80-84, 85-89, and 90 and older. One-year survivor was not seen in the patients who underwent non-curative operation for cancer. By Cox's proportional hazard model, curative operation was defined as a positive factor for postoperative survival and emergency operation was defined as a negative factor for postoperative survival. These results suggest that adequate and optimal surgical procedures considering physical and psychological status enable a reduced surgical mortality, and may contribute to the quality of life of the elderly patients.