INTRODUCTION: With rising life expectancy and low birth rates, elderly people make up an increasing proportion of the population of the United States. Studies estimate that by 2050, the nonagenarian population will reach 8.7 million. Elderly people have significant medical care needs and their need for surgical care will require nuanced evaluation of their surgical candidacy and operative risks.METHODS: A retrospective analysis was performed through chart review to identify nonagenarians and centenarians who underwent acute care surgery over 6 years at our community hospital. Demographic and surgical data were found and compared to outcomes to assess factors that impact outcome.RESULTS: 120 patients over the age of 90 underwent 124 surgical procedures at our institution between 2015 and 2020. Ages ranged from 90-101, with 61% women and 39% men. The most common procedures performed were cholecystectomy ( 18), open groin hernia repair (13), and laparotomy with large bowel resection (12). Congestive heart failure, dementia, American Society of Anesthesia score and Johns Hopkins Class of Surgery were associated with increased mortality, while hyperlipidemia was protective. 33% of patients developed postoperative complications and 42% required an ICU stay while 84% survived to discharge.CONCLUSION: Although surgery is often avoided in elderly patients, especially those over ninety, many patients in this population tolerate acute care surgery well with a vast majority surviving to discharge. With appropriate discussion with the patient on risks, benefits, and alternatives to surgery, it is appropriate to proceed to the operating room.