Background Hip fractures in the elderly constitute a significant health challenge due to their association with increased mortality, complications, and loss of functional independence. These consequences are exacerbated in resource-limited settings such as India, where delays in surgical management and limited rehabilitation support remain pervasive. Objectives This study aimed to assess the influence of frailty, surgical timing, and comorbidities on one-year mortality and morbidity in elderly patients with operated hip fractures. Methods A prospective observational study was conducted at Mandya Institute of Medical Sciences from January to December 2024. One hundred patients aged ≥60 years with radiologically confirmed traumatic hip fractures who underwent surgical intervention were included. Demographics, comorbidities, Clinical Frailty Scale (CFS) scores, timing of surgery (≤48 hours vs. >48 hours), and postoperative outcomes (in-hospital complications, Katz Index for ADL, 6-month and 1-year mortality) were analyzed. Results The mean age was 73.1 ± 7.2 years, with females comprising 63%. Early surgery (≤48 hours) was performed in 62% of patients. Frailty (CFS ≥5) was observed in 36% of patients. One-year mortality was 20%, with significantly reduced mortality in those operated early (15% vs. 32%, p=0.02) and fewer complications (21% vs. 45%, p<0.01). Frailty independently predicted mortality (OR 3.2). Conclusion Early surgical intervention and frailty assessment are pivotal in predicting outcomes following hip fracture surgery. There is a pressing need for systemic improvements in LMICs, including fast-track surgical pathways and geriatric rehabilitation services.

Hip Fracture, Frailty, Elderly, Early surgery, Mortality, India.