Purpose <p>This study analyzes the perioperative factors influencing the risk of transfusion in patients with osteoporotic hip fractures and their relationship with 30-day mortality.</p> Methods <p>This is a retrospective analytical study that included patients over 65 years old diagnosed with hip fracture admitted to our hospital from March to October, 2023. They were treated according to the hospital’s osteoporotic hip fracture management protocol. Data collected included admission day, age, sex, type of fracture, anticoagulant or antiplatelet treatment, time to surgery, and 30-day mortality.</p> Results <p>A total of 348 patients (77.3% women) with a mean age of 85.3 (SD 7.51) years were included. The mean hemoglobin level at admission was 12.6 (SD 1.66) mg/dl. The mean time to surgery was 2.51 (SD 1.45) days. The proportion of patients transfused was 42%, and the 30-day post-discharge mortality rate was 4.6%. Multivariate analysis showed that age, type of fracture, hemoglobin level at admission, and surgery within the first 48&#xa0;h were associated with a higher transfusion rate (<i>p</i> &lt; 0.05). No differences were found regarding sex and prior anticoagulant or antiplatelet treatment. The 30-day mortality was higher in the transfused group.</p> Conclusions <p>Age; hemoglobin level at admission; subtrochanteric, pertrochanteric, and basicervical fractures compared to subcapital fractures; and surgery within the first 48&#xa0;h were associated with a higher transfusion rate. Multidisciplinary perioperative management of patients who cannot be operated on within the first 48&#xa0;h is crucial to prevent complications and improve survival.</p>