This study evaluates our experience with an early surgical approach in 52 consecutive patients over the age of 65 years. Eighteen patients were taken to the operating room for early excision (less than 7 days postburn) and 34 patients were excised after 7 days (late excision). The early and late excision groups were matched for age, sex, and size of burn. In survivors, the early excision group had a 32% reduction in mean hospital stay (p less than 0.05). In addition, early surgical excision resulted in fewer episodes of sepsis and pneumonia (p less than 0.05). However, there was no significant improvement in age- and burn size-specific survival in the early excision group (p greater than 0.05). We conclude that elderly patients represent a high-risk population, and that early surgical excision results in fewer episodes of infection and a reduction in hospital stay but does not significantly improve survival.