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BACKGROUND Whether perioperative blood transfusions are associated with long-term outcomes remains controversial. This study aimed to evaluate the effect of blood transfusions on overall survival in hip fracture patients. METHODS This retrospective survey was conducted at a single medical center and enrolled patients aged ≥ 70 years who received hip fracture surgery between 2013 and 2015. Multivariate Cox regression analysis was used to estimate the effect of blood transfusions on overall survival after surgery. Furthermore, patients who received a blood transfusion were further matched to those who did not receive a blood transfusion by patient characteristics. Stratified Cox regression analysis was used to assess the effect of transfusions on overall survival after matching. RESULTS A total of 718 patients with a median follow-up period of 25.9 months were included in the analysis, of whom 495 (68.9%) received a blood transfusion. Four independent risk factors for mortality were identified, including male sex (hazard ratio (HR): 1.48, 95% confidence interval (CI): 1.01-2.17), aging (HR: 1.03, 95% CI: 1.0-1.06), general anesthesia (HR: 1.61, 95% CI: 1.11-2.31), and anemia status (mild versus no anemia, HR: 1.67, 95% CI: 0.96-2.90; moderate versus no anemia, HR: 4.14, 95% CI: 2.35-7.3). The effect of blood transfusions on overall survival was non-significant after adjusting for the selected risk factors (HR: 1.44, 95% CI: 0.87-2.36). After matching, the effect of blood transfusions on overall survival remained non-significant (HR: 1.7, 95% CI: 0.78-3.71). CONCLUSION No association was found between blood transfusions and overall survival among elderly patients undergoing hip fracture surgery. More prospective studies are necessary to elucidate the association between blood transfusions and long-term outcomes in patients receiving hip fracture surgery.