Elderly patients are often viewed as high-risk surgical candidates. Consequently, elective surgery may not be performed, with the result that a potentially treatable disease process may develop into an acute catastrophic event. We question the validity of this approach. In our experience with 1,411 gastrointestinal (GI) surgical procedures performed between March 1972 and September 1979, 23.6% have been in patients older than 70 years of age. The operations were emergent in this age group 19.5% of the time. Despite the advanced age of these individuals, the overall operative mortality for 269 elective procedures was 6.7%. For the 65 patients aged 70 years or older who underwent emergency procedures, the operative mortality was 20%. While elective GI surgery in the elderly has a significant risk, death is almost always the result of an associated disease (pulmonary, renal, or cardiac). Emergency procedures in the elderly indeed carry greater risk, statistically the same as in the 50- to 69-year-old group. Death is frequently related to an acute process complicating a treatable disease.