Objective: To perform a meta-analysis evaluating the impact of different anesthetic techniques on the postoperative recovery, mobility, and overall outcomes of elderly patients with hip fractures, with a focus on implications for physical rehabilitation and functional recovery. Methods: A comprehensive literature search was conducted across PubMed, the Cochrane Library, EMBASE, the Chinese Journal Full Text Database, and the Wanfang database up to July 31, 2022. Relevant studies were analyzed using RevMan 5.2 software, and statistical testing was applied to assess the influence of anesthesia type on postoperative outcomes. Meta-analyses were performed on key indicators, including in-hospital mortality, postoperative delirium, length of hospital stay, and 1-year postoperative mortality. Results: Twelve high-quality studies were included in the final analysis, comprising three randomized controlled trials (RCTs) and nine observational studies (OS). The meta-analysis revealed the following: In-hospital mortality: Regional anesthesia significantly reduced in-hospital mortality compared to general anesthesia (RR = 0.81, 95% CI 0.75–0.88, P < 0.01). Postoperative delirium: No significant difference in the incidence of postoperative delirium was observed between the two groups (RR = 0.95, 95% CI 0.79–1.14, P > 0.05). Hospital stay: Regional anesthesia was associated with a shorter postoperative hospital stay compared to general anesthesia (RR = -0.04, 95% CI -0.06 to -0.03, P < 0.01). 1-year mortality: No clinically meaningful difference was noted in 1-year mortality between the groups (RR = 1.04, 95% CI 0.84–1.30, P > 0.05). Conclusion: Regional anesthesia offers significant advantages in reducing in-hospital mortality and hospital stay duration in elderly patients with hip fractures, facilitating earlier initiation of rehabilitation and improving functional recovery potential. However, no differences were observed in the incidence of postoperative delirium or 1-year mortality between regional and general anesthesia. These findings suggest that regional anesthesia may be a preferable option for promoting postoperative recovery and readiness for physical activity, aligning with rehabilitation goals for maintaining mobility and quality of life in elderly patients. Future studies should further explore the role of anesthetic techniques in supporting long-term functional outcomes and participation in physical rehabilitation programs.