Summary Question Does early surgical repair (within the first twenty-four hours) of hip fracture improve outcomes in elderly people? Study Design Prospective cohort study. Main Results Median time to surgery was 19 hours for early surgery and 41 hours for later surgery. Early surgical repair of hip fracture reduced the number of days of severe and very severe pain in elderly people compared with surgery after twenty-four hours (days of severe and very severe pain: -0.22 days, 95%CI -0.41 to -0.03). Early surgical repair also reduced the length of hospital stay (-1.94 days, p < 0.001 ). Early surgery improved self-care scores at 6 months (difference in scores -1.1, 95% CI -2.18 to -00.04, p = 0.04 ). Early surgery had no effect on death or locomotion at 6 months (mortality: HR 0.75, 95%CI 0.52 to 1.08; locomotion: -0.04 points, 95%CI -0.49 to 0.39). Authors’ Conclusions Early surgical repair of hip fracture reduces pain and hospital stay in elderly people, but has no effect on death or locomotion.