Purpose <p>This study aimed to investigate the association between smoking and the incidence of preoperative deep venous thrombosis (DVT) after hip fracture in geriatric patients.</p> Methods <p>This retrospective cohort study included 1,190 geriatric patients who underwent surgery for hip fractures. Patients were categorized into smokers and non-smokers based on their smoking history. Multivariable logistic regression analyses were conducted to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for preoperative DVT, controlling for potential confounders. Propensity score matching (PSM) was employed to minimize confounding variables, including age, sex, and comorbidities. Additionally, a dose–response analysis was performed to assess the relationship between the intensity of smoking and the probability of preoperative DVT.</p> Results <p>The incidence of preoperative DVT was significantly higher in smokers compared to non-smokers before PSM (27.6% vs. 11.9%, <i>p</i> &lt; 0.001) and after PSM (26.3% vs. 11.4%, <i>p</i> &lt; 0.001). Smoking was an independent predictor of increased preoperative DVT risk, with an adjusted OR of 3.68 (95% CI 2.23–6.08, <i>p</i> &lt; 0.001) after multivariable regression and 2.75 (95% CI 1.47–5.14, <i>p</i> &lt; 0.001) after PSM. A dose–response relationship was observed between smoking intensity and preoperative DVT risk.</p> Conclusions <p>Smoking is an independent risk factor for preoperative DVT after hip fracture in geriatric patients. Moreover, a dose–response relationship was observed, with higher smoking intensity corresponding to a greater risk of DVT.</p>