BACKGROUND: The incidence of hip fractures in the elderly is increasing because of the expanding elderly population. These patients usually have accompanying chronic illness. We have reviewed 108 cases for hip fracture surgery to determine the factors which influence the intraoperative and postoperative outcome. METHODS: One hundred eight patients, aged 65 year or more, undergoing surgery for hip fracture were reviewed retrospectively according to age, sex, preoperative laboratory findings, pre-existing concomittent disease, type of anesthesia, amount of estimated blood loss during operation, changes of blood pressure, heart rate during anesthesia and postanesthesia care unit, one month morbidity and mortality. RESULTS: Seventy-one patients had pre-existing concomittent disease. Decrease in mean arterial pressure and tachycardia were less frequent in combined spinal epidural anesthesia than spinal anesthesia. Increase in mean arterial pressure was less frequent in combined spinal epidural anesthesia than epidural and general anesthesia during surgery. There was a significantly high postoperative morbidity among patients with concomittent disease. One month mortality increased with increasing age. CONCLUSIONS: We recommend the combined spinal epidural anesthesia in patients who could aggravate the pre-existing concomittent disease when hypotension, hypertension or tachycardia occurs during operation. One month morbidity was related to pre-existing concomittent disease, whereas mortality was related to age. More studies are needed to focus on well-defined risk groups in the elderly patients.