Overall, 58,719 patients were identified that underwent surgery for prolapse including 36,889 under 65 years of age, 18,735 between ages 65 and 79, and 3,095 over 80. Compared to the index population of patients under 65, patients in the elderly and very elderly groups had lower BMI, were less likely to smoke, less likely to be independent, had higher rates of diabetes, COPD, and cardiovascular disease, were more likely to undergo extraperitoneal apical suspension or obliterative surgery, and less likely to undergo intraperitoneal apical prolapse suspension (all p<0.001). Rates of surgery for incontinence were similar. The rate of serious complications in the index population was 5.1%. Comparatively, elderly patients had a similar rate of serious complications at 4.8% (OR 0.9, 0.87-1.02, p=0.07), while the very elderly experienced a higher rate of serious complications at 10.7% (OR 2.2, 2.0-2.5, p<0.0001). The very elderly had significantly elevated risk of cardiac complications (OR 14.1, 7.5-26.7), stroke (OR 23.9, 6.6-87.1), non-home discharge (OR 11.4, 9.1-14.4), and mortality within 30 days of surgery (OR 35.9, 10.5-122.4) (all p<0.0001). On multivariate logistic regression, after controlling for confounders, age over 80 remained an independent predictor of serious complications (OR 2.1, 1.8-2.4, p<0.001).