I thought about writing the sentence "She underwent surgery at 4 year old.", but I thought it sounded weird without seeming technically wrong, but is it? I definitively think "She underwent surgery at age 3" sounds better, but I would like to know why the former is wrong if it is.

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    We'd say "at 4 years old", but otherwise it sounds fine to me. – The Photon Jan 23 '19 at 1:18

"She underwent surgery at 4 years old." is fine, but note that "years" should be plural because we are talking about 4 of them.

We do have an idiomatic expression which is an exception to that concept (i.e. plural "years"). A "4 year old" or (hyphenated sometimes) "4-year-old" is a 3-word noun meaning a child who is 4 years old.

So you could say,

"She underwent surgery as a 4 year old."

"She underwent surgery at 4 years old."

"She underwent surgery at age 4."

All three sound equally natural to me.

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