Background <p>Vitamin D deficiency has been linked to poor health outcomes in older adults, but its impact on perioperative outcomes following hip fracture surgery remains unclear.</p> Aims <p>To examine associations between serum vitamin D status and selected clinical outcomes in elderly patients undergoing hip fracture surgery.</p> Methods <p>This retrospective single-center study included 198 patients aged &gt;65 years who underwent hip fracture surgery between January 2022 and January 2024. Patients were categorized into normal (&gt;30 ng/mL), insufficiency (10-30 ng/mL), and deficiency (&lt;10 ng/mL) groups. Outcomes included length of hospital stay, in-hospital falls, infection, 30-day readmission, and one-year mortality.</p> Results <p>Patients with normal vitamin D levels had shorter hospital stays (5.8 ± 2.2 days) than those with insufficiency (6.1 ± 3.2) or deficiency (7.9 ± 4.9) (p=0.001). Vitamin D deficiency was also associated with a higher rate of in-hospital falls (47.2% vs. 15.4% and 3.6%, p&lt;0.001). No significant associations were observed with infection, readmission, or mortality.</p> Conclusions <p>Lower vitamin D levels were associated with longer hospitalization and higher fall risk in elderly hip fracture patients. These findings highlight a possible role of vitamin D status in perioperative recovery, but given the retrospective design and single-center sample, conclusions should be interpreted with caution.</p>