Alcohol septal ablation (ASA) and septal myectomy (SM) are therapeutic interventions for patients with hypertrophic cardiomyopathy (HC) who remain symptomatic despite medical treatment. Outcomes for both interventions in age groups ≤65 versus >65 years are scarce. We queried the National Readmission Database for adult patients undergoing either SM or ASA between 2010 and 2015 for HC. Patients were divided into 2 age-groups (≤65-years and >65-years). We aimed to compare the in-hospital mortality, complication rates, and resource utilization for each procedure between the 2 age-groups. We identified 4,358 patients with HC who underwent intervention, of which 2,113 were treated with SM and 2,245 with ASA. In-hospital mortality was 6-times higher in patients ≤65 years old who underwent SM compared with ASA (1.5% vs 0.3% odds ratio 6.2; p = 0.04); and 4-times higher in patients >65 years treated with SM compared with ASA (6.7% vs 1.7% odds ratio 4.29; p = 0.04). Blood transfusion rates and stroke were higher in patients undergoing SM, regardless of their age-group. Length of hospital stay was lower in the ASA group (3 days vs 6 days for both age groups, p <0.001) as well as median hospital costs (≤65 years old: $15,474 vs $31.531; and >65 years old: $16,672 vs $36,042, p <0.001). In conclusion, patients with HC treated with ASA had significantly lower in-hospital mortality, complications rates, length of hospital stay, and hospital costs compared with patients undergoing SM at any age.