Objective To investigate the incidence of postoperative stroke and its independent risk factors in elderly patients with hip fractures. Methods A total of 1 296 patients who were admitted to Linyi People's Hospital for elective hip fracture surgery from June 2019 to June 2022 were selected and their clinical data were retrospectively analyzed. According to the presence of stroke within 30 d after surgery, the patients were divided into two groups: a stroke group (n=30) and a non‑stroke group (n=1 266). Both groups were compared for baseline data, preoperative laboratory data, anesthesia‑related data, and fracture and surgery‑related data through univariate analysis. Then, factors with P<0.2 in the univariate analysis were included in multivariate logistic regression analysis to investigate the incidence of postoperative stroke and its independent risk factors in elderly patients with hip fractures. Results A total of 1 296 patients were enrolled in this study, of whom 30 had postoperative stroke, with an incidence rate of 2.3%. The results of multifactorial logistic regression analysis showed that the independent risk factors for postoperative stroke in elderly patients with hip fracture were American Society of Anesthesiologists (ASA) classification Ⅲ and Ⅳ [odds ratio (OR) 4.441 (95% confidence interval (CI) 1.243, 15.861), P=0.022], higher preoperative red blood cell distribution width (RDW) [OR 1.057 (95%CI 1.006, 1.110), P=0.027], carotid plaque [OR 2.760 (95%CI 1.191, 6.395), P=0.018], and intraoperative hypotension [OR 2.641 (95%CI 1.217, 5.730), P=0.014]. Conclusions The incidence of postoperative stroke in elderly patients with hip fracture is 2.3%. ASA classification Ⅲ and Ⅳ, carotid plaque, higher preoperative RDW, and intraoperative hypotension are the independent risk factors for postoperative stroke in elderly patients with hip fracture.