Abstract Background To evaluate the surgical safety in myasthenia gravis (MG) patients aged 65 and over. Methods A total of 564 patients with MG who underwent surgery in the Department of Thoracic Surgery of Beijing Hospital from November 2011 to March 2022 were included in the study and divided into two groups taking the age of 65 as the boundary. Perioperative data of patients were recorded and statistically analyzed. Results Compared with young patients, FEV1, FEV1% and MVV in lung function of elderly MG patients were worse (p