We found no previous work examining outcome after blunt traumatic aortic laceration (TAL) that has focused on elderly patients (age > 55 years) with this lesion. A 20-year retrospective review from two trauma centers of survival outcome for patients with TAL was performed to assess the effects of surgical therapy in the elderly cohort. Seventy-five cases were identified. Patients were assigned to one of two groups (Young < 55 or Old > or = 55) and data were analyzed for differences between them. There was a significantly higher mortality rate in the elderly patients (82.4% Old vs. 12.1% Young; p < 0.001). Moreover, surgical treatment in the Old group had up to a 163-fold increased likelihood of mortality compared with surgical treatment in the Young group (p < 0.001). We conclude that Old patients have higher mortality associated with surgical repair of TAL. Because of the increased risk of surgical intervention for TAL, elderly patients may be candidates for nonsurgical management as has been advocated for patients with asymptomatic peripheral traumatic pseudoaneurysms.