Purpose <p>Elderly oral cavity cancer patients form a unique cohort with multiple therapeutic considerations. The Oral Cancer Survival Calculator^® has been used to estimate the risk of cancer-specific deaths in patients with oral cancer. The aim of our study was to evaluate surgical outcomes and cancer-specific survival in elderly oral cavity cancer patients using the calculator.</p> Methods <p>Retrospective outcome analysis of elderly (&gt;/=70 years) oral cavity cancer patients undergoing surgery at a rural-based tertiary academic institution was performed. The calculator was used to decipher health adjusted age (HAA), estimated 1-, 2- and 5-year overall survival (OS) and cancer specific deaths. Chronological age and HAA-related outcomes were analysed.</p> Results <p>Ninety-seven elderly patients (median age: 74 years) underwent surgery. Post-operative complications were noted in 18.6%, with an overall mortality of 14.4%. Presence of comorbidities (<i>p</i> &lt; 0.001) and the need for tracheostomy (<i>p</i> &lt; 0.001) significantly increased complication rates. Using the calculator, the estimated 1-, 2- and 5-year OS and cancer-related deaths was 84%, 71% and 37% and 14%, 26% and 37% respectively. However, the accuracy of the calculator in predicting deaths was 55.5%. HAA, obtained from the calculator, was lower than the corresponding chronological age in 57.7% of patients and was associated with lower post-operative complications (7.1%) and re-admission (1.8%) rates.</p> Conclusions <p>HAA was predictive of lower complication and re-admission rates after surgery in elderly oral cavity cancer patients. The Oral Cancer Survival Calculator ^® showed a moderate prediction for mortality. However, larger studies are needed to validate these findings.</p>