Two hundred and thirty-five patients over 60 years of age underwent operation for peptic ulcer disease. Overall mortality was 16%. Mortality increased with age, with site of ulcer, and with amount of preoperative bleeding. The primary surgical procedure had little influence on mortality. Subtotal gastrectomy was more successful than vagotomy and drainage when reoperation was required. There was a high initial mortality with suture ligature and a high recurrence rate with closure of perforation. The cause of death was recurrent hemorrhage or anastomotic leak in 24% of patients, cardiopulmonary failure in 44%, prolonged hypotension in 16%, stroke in 8%, and hepatic failure in 8%. Of 195 patients surviving operation, 75% were alive after one year and 50% were alive four years later. Only 10% of the subsequent deaths were related to ulcer disease.