BackgroundPrevious studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients undergoing hip fracture surgery have not produced consistent results. The aim of this systematic review and meta-analysis was to compare the hip fracture surgery.MethodsWe performed a systematic review and meta-analysis to compare the effects of general anesthesia with regional anesthesia on in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium in adult hip fracture patients (≥ 18 years). Between January 1, 2022, and March 31, 2023, a systematic search was performed for retrospective observational and prospective randomized controlled studies in PubMed, Ovid Medline, Cochrane Library, and Scopus.ResultsTwenty-one studies including 363,470 patients showed higher in-hospital mortality in the general anesthesia group compared with regional anesthesia (OR = 1.21; 95% CI 1.13–1.29;P< 0.001,n= 191,511). The 30-day mortality (OR = 1.00; 95% CI 0.96–1.05;P= 0.95,n= 163,811), the incidence of postoperative pneumonia (OR = 0.93; 95% CI 0.82–1.06;P= 0.28,n= 36,743) and the occurrence of postoperative delirium in the two groups (OR = 0.94; 95% CI 0.74–1.20;P= 0.61,n= 2861) had no significant difference.ConclusionRegional anesthesia is associated with reduced in-hospital mortality. However, the type of anesthesia did not affect the occurrence of 30-day mortality, postoperative pneumonia, and delirium. A large number of randomized studies are needed in the future to examine the relationship between type of anesthesia, postoperative complications, and mortality.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12871-023-02150-9.