Thirteen randomized controlled trials (RCTs) with a total of 3,736 elderly patients undergoing hip fracture surgery were included in this systematic review and meta-analysis comparing general anesthesia (n=1,885) and regional anesthesia (n=1,851). The primary outcome of interest was the incidence of post-operative delirium and post-operative mortality. Secondary outcomes of interest included intra-operative outcomes, post-operative pain, length of stay, and adverse events. The meta-analysis results demonstrated no significant differences between the two anesthesia techniques with respect to the odds of post-operative delirium or mortality. However, regional anesthesia was associated with significantly reduced operative time and intra-operative blood loss, lower pain scores, shorter length of stay, and a reduced odds of acute kidney injury vs. general anesthesia. The findings of this meta-analysis suggest that regional anesthesia, while not reducing the risk of delirium or death, could reduce resource consumption, the risk of kidney injury and lower post-operative pain for elderly patients undergoing hip fracture surgery.