Ten randomized controlled trials including 3,968 elderly hip fracture patients were included in this systematic review and meta-analysis comparing neuraxial anesthesia and general anesthesia. The outcomes of interest included post-operative delirium incidence, mini-mental state examination, neuropsychological tests, post-operative pain, length of stay and discharge location, and mortality (in-hospital, 30-day, 90-day). The results of the meta-analysis found no differences between general anesthesia and neuraxial anesthesia in all outcomes. Sub-group analyses by the inclusion of patients with pre-existing delirium yielded similar results for post-operative delirium incidence and length of stay. The results of this study suggest that general and neuraxial anesthesia result in similar levels of post-operative delirium and delirium-associated outcomes.