Operations on the abdominal viscera are common among the elderly. Few of the operations are truly elective, with the majority being either scheduled reasonably shortly after a diagnostic procedure or truly emergent procedures necessitated by the presence of an intraabdominal catastrophe. The impact of abdominal surgery on the elderly is significant and the potential for complications is high. This chapter synthesizes current thought to provide an approach to the elderly abdominal surgical patient including both emergent and elective surgeries. It should be stated that there are relatively few prospective trials regarding the perioperative management of abdominal surgery in the elderly. There is a good amount of retrospectively acquired information that provides direction to both current care paradigms as well as ongoing research. Major vascular surgery may involve an abdominal approach; however, vascular surgery, particularly in the elderly, is becoming the province of endovascular surgery and is not covered in this chapter.