Background: Prognostic Nutritional Index (PNI) and the Geriatric Nutritional Risk Index (GNRI) scores are commonly used nutritional indexes. These scores can provide objective assessment to both surgeon and patient of peri-operative risk as well as long term survival. Aim: To determine the use of nutritional scoring tools as predictors of short- and long-term outcomes in elderly patients undergoing surgery in Tasmania, Australia. Methods: The study was approved by the Human Research Ethics Committee of the Royal Hobart Hospital, Tasmania. Retrospective cohort study of elderly patients who underwent surgery from 2015-2020. Statistical analyses were performed using appropriate statistical software with significance set at α = 0.05. Patient demographics, comorbidities and nutritional indices were compared between survival groups using univariate and multivariate cox regression analysis. Kaplan-Meier survival curves were constructed for both, with survival differences assessed using log-rank tests. Results: One hundred and twenty-two patients aged >70 years underwent surgery. Short-term complications including MACE and 30-day mortality were associated with patients with low GNRI and PNI scores (p<0.05). Lower PNI scores and DLCO were independently associated with decreased overall survival with a mean follow-up of 4 years. Specifically, each unit increase in PNI was associated with a 6% reduction in the hazard of death (HR 0.94, p = 0.012), and each percentage point increase in DLCO was associated with a 3% reduction in the hazard (HR 0.97, p = 0.037). Multivariate analysis demonstrated GNRI score (<101) was significant as a predictor for re-admission and PNI score (<47) was significant as a predictor for rehab (p<0.05). Conclusion: Nutritional scoring tools can provide useful prognostic information and should be utilised routinely pre-operatively to risk stratify and allow for optimisation pre-operatively.