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Objectives To analyze the postoperative complications associated with cochlear implant (CI) surgery in a large consecutive case series of older adults (≥ 60 years) Study Design Retrospective case review Setting Tertiary referral center Patients 445 individuals ≥60 who received a first CI between1999–2011 Interventions Cochlear implantation Main Outcome Measure(s) Postoperative complications classified as major (meningitis, immediate postoperative facial weakness, device failure, flap dehiscence, surgical removal) and minor (surgical site infection, balance problems, delayed postoperative facial weakness, facial nerve stimulation) Results The mean age at implantation was 72.7 years (60–94.9) and the median duration of follow-up was 4.8 years (0.1–12.5). There were 42 minor complications in 41 patients (9.2%) and 36 major complications in 21 patients (4.7%). Seventeen patients (3.8%) required surgical device removal, 15 of whom underwent reimplantation. A Kaplan-Meier analysis of rates of device explantation demonstrated that at 5 and 10 years after CI, respectively, 95.4% and 93.1% of patients retained their original CI. When comparing complications between patients aged 60–74 years and those aged 75 years and older, there was a higher prevalence of balance problems lasting more than 1 month in the older group (9.5% vs. 4.9%, p = .05). Conclusions Our results indicate that the safety profile of cochlear implantation in an older population is comparable to that of younger adults and children. We suggest that concerns for increased postoperative complications in patients of advanced age do not need to be a primary consideration when determining CI candidacy.