BACKGROUND: As the population ages and as surgical and anaesthetic techniques advance, more elderly people will be referred for surgery. Postoperative mortality and morbidity are certainly associated with increasing age; however the severity of coexisting medical conditions is an equally important risk factor. In the present study we tried to look into the aetiology of early postoperative morbidity of elderly patients following major surgery, in relation to their medical history.FINDINGS: Fifty patients aged 70 to 95 years of age were enrolled in the study. All patients had undergone major elective orthopedic procedures due to either osteoarthritis of femoral head or femoral neck fracture. Patients were followed up by telephone interview one month following their discharge. 8 out of 50 patients (16%) were reported dead at follow up. For the majority of the patients who died, the cause of death was directly related to their previous medical history.CONCLUSION: Despite the detailed preoperative evaluation, and the intensive intraoperative and early postoperative anaesthetic care, most patient's deaths were related to their previous medical history.