OBJECTIVE To determine morbidity and mortality in elderly patients following hip fracture surgery in Egypt and its correlates and to determine the utility of the POSSUM scale to predict morbidity and mortality among our population. METHODS We assessed postoperative morbidity and mortality following hip fracture surgery in a 6-month prospective observational study of 100 elderly patients who were undergoing surgical repair at the beginning of the study. The exclusion criteria included surgically unfit patients and patients refusing to participate in the study. The study was conducted in Ain Shams University Hospital, Ain Shams Specialized Hospital, and El-helal Hospital. RESULTS The subjects were categorized as survivors and nonsurvivors according to the 6-month mortality, and the groups were compared statistically according to this classification. The observed 6-month mortality was 19.56%. POSSUM had high specificity for predicting 6-month survival (97.3%). A multivariate regression analysis revealed that postoperative admission to the intensive care unit and lack of ambulation were major risk factors associated with the 6-month mortality. CONCLUSIONS The POSSUM system had high specificity for predicting survivors (97.3%) but failed to predict mortality (sensitivity = 5.6%). The major risks for 6-month mortality are intensive care unit admission and lack of ambulation.