Background: Nowadays surgery remains the best treatment for localized lung cancer (LC). However, patients over 80 years old are often denied surgery because of the postoperative risk of death. This study aimed to estimate in-hospital mortality (IHM) and determine whether age over 80 is the most important predictor of IHM after LC surgery.Methods: From January 2005 to December 2015, 97,440 patients, including 4,438 patients over 80 years old, were operated on for LC and recorded in the French Administrative Database. Characteristics of patients, hospitals and surgery were analysed.Results: Crude IHM was 3.73% (n=3,639) and 7.77% (n=345) for the over 80s vs. 3.54% (n=3,294) for younger patients (P<0.0001). In multivariate analysis, predictive factors for IHM with the odds ratios (OR) were: 2.60 for age ≥80 (95% CI: 2.30–2.94; P=0.0001), 5.85 for a previous liver disease (95% CI: 4.79–7.16; P=0.0001) and 5 for previous lung disease (95% CI: 4.25–5.9; P=0.0001). IHM was also linked to hospital volume with an OR of 0.75 (95% CI: 0.69–0.81; P=0.0001) and a linear decrease for predicted IHM according to hospital volume for the over 80s. Adjusted ORs were 1.15 (95% CI: 0.96–1.4; P=0.0116) for lobectomy, 2.18 for bilobectomy (95% CI: 1.7–2.8; P=0.0001) and 3.83 (95% CI: 3.2–4.6; P=0.0001) for pneumonectomy.Conclusions: Concerning IHM, age ≥80 had a lower weight than did a previous pulmonary or liver disease and the type of pulmonary resection. Patients over 80s with localized LC and no significant comorbidities should be referred for surgery if lobectomy or sublobar resection could be performed.