Hip fractures in older adults are associated with mortality risk despite advances in perioperative care. Although early mobilization improves short-term outcomes, its effect on long-term survival remains uncertain.

To evaluate the association between early postoperative mobilization and long-term mortality in older adults undergoing fast-track hip fracture surgery.

This retrospective cohort study included participants aged ≥60 years treated within a Hip Fast-Track Surgery program between 2018 and 2024. Participants were classified as early (≤24 hours) or late (>24 hours) mobilization. Stabilized inverse probability of treatment weighting (sIPTW) was employed to adjust for baseline characteristics and postoperative complications. Mortality was ascertained via the National Civil Registry. Survival was analyzed using Kaplan–Meier methods and Cox proportional hazards models.

Among 680 participants (early mobilization: n = 214; late mobilization: n = 466) with a median follow-up of 2.41 years, early mobilization was associated with higher survival (log-rank, P < 10 ^-3 ). No deaths were observed in the early mobilization group during hospitalization or within 6 months. After sIPTW adjustment, early mobilization was associated with a 94% reduction in 1-year mortality (adjusted HR 0.06; 95% CI, 0.01-0.41; NNT=8) and a 61% reduction in overall mortality (adjusted HR 0.39; 95% CI, 0.22-0.70; NNT=4). Adjusted postoperative length of stay did not differ between groups.

Early mobilization within 24 hours after fast-track hip fracture surgery is associated with substantial reductions in short- and long-term mortality in older adults. Given the observational design and substantial residual confounding, findings should be interpreted as hypothesis-generating associations rather than causal effects.