Background and Objectives: To compare 30-day mortality of elderly patients with hip fractures before and after the implementation of Fast Track Surgery for Hip Fracture Program. Additional with compare of 30-day readmission rate, length of stay and medical complication and the impact of COVID-19 on every outcome Method: We conducted an observational cohort study of patients aged 60 or over with hip fracture diagnosis during the pre-implementation period (Oct 2017–Sep 2020) and post-implementation period (Oct 2020-Sep 2021), enrolled from 20 hospitals in Thailand, in which the COVID-19 outbreak was March 2020. The pathologic fracture, multiple fractures, multiorgan injuries were excluded. Data were collected from discharge summaries submitted to the National Health Security Office. The 30-day mortality was analyzed using cox proportional hazard regression analysis with an adjustment for potential confounders. Results: With 9,838 and 480 patients in pre- and post-implementation periods respectively. The mean age was 77.49±8.64 and 78.19±8.35 years, with most being female (72.7% and 77.1%). The post-implementation group had a higher prevalence of cerebrovascular disease (5.9% and 7.4%), Ischemic heart disease (2.9% and 3.7%), hypertension (45.6% and 49.4%) and diabetes mellitus (21.5% and 24.7%). In the adjusted model, 30-day mortality in the post-implementation group was not significantly different (HR 0.83; 95%CI 0.53-1.28, p = 0.41). The median length of stay was lower in the post-implementation group (8(0-23) and 7(0-30) days, p<0.001) also 30 day-readmission (1.6% and 0.21%, p<0.014). There was no difference in mortality and complication in the COVID-19 outbreak, as compared with nonCOVID-19 period. Conclusions: Hip Fracture Fast Track Program had a tendency to be lower in 30-day mortality. The length of stay and 30 day-readmission was significant lower. There was no significant difference in 30-day mortality in COVID-19 outbreak

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