Purpose <p>Femoral neck fractures in older adults are commonly treated with hip hemiarthroplasty (HA). Many older adults who sustain femoral neck fractures are also receiving long-term anticoagulation therapy, which may negatively affect patient outcomes after HA. We sought to investigate whether long-term anticoagulation therapy is associated with increased risks of surgical wound complications among older adults treated with HA for femoral neck fracture.</p> Methods <p>Patients ≥ 60&#xa0;years old who underwent HA within two days of admission for femoral neck fracture between October 1, 2015-December 31, 2021 were identified using codes in the Premier Healthcare Database. Long-term anticoagulation therapy was defined as an active prescription of anticoagulant medication at time of admission. A propensity score for the probability of long-term anticoagulant therapy was used to match patients. The adjusted odds of 90-day infectious surgical wound complications (deep and superficial) and non-infectious surgical wound complications (wound dehiscence, seroma, or hematoma) were determined from the matched patients.</p> Results <p>7218 patients on long-term anticoagulation therapy were matched to 7218 patients with no history of anticoagulation therapy. Patients with a history of long-term anticoagulation therapy experienced higher unadjusted rates of non-infectious surgical wound complications (2.15% vs. 1.29%, <i>p</i> &lt; 0.001). No difference in the incidence of surgical site infection was observed between groups (1.73% vs. 1.30%, <i>p</i> = 0.111). After propensity score matching, patients on long-term anticoagulation therapy had higher odds of non-infectious (adjusted odds ratio [aOR]: 1.65, 95% confidence interval [CI] 1.27–2.15, <i>p</i> &lt; 0.001) and infectious (aOR: 1.38, CI 1.05–1.81, <i>p</i> = 0.021) surgical wound complications.</p> Conclusion <p>Long-term anticoagulation therapy confers an independent risk of wound complications among older adults undergoing HA for femoral neck fracture.</p>