Objective To determine the effect of pre-operative serum albumin (ALB) level and total lymphocyte count (TLC) on the prognosis of hip fracture in the elderly patients. Methods Clinical data of 640 elderly patients (over 60 years old) with hip fracture undergoing surgical treatment in our department from July 2006 to December 2010 were collected and retrospectively analyzed in this study. Their serum ALB level and TLC were recorded at admission. Their hospitalization time, in-hospital complications, and mortality at hospital and at 3 and 12 months after surgery were analyzed. Cox regression analysis was carried out on these data. The clinical significance of serum ALB level and TLC was evaluated in the prediction of prognosis. Results Among the 640 patients, those with lower serum ALB level accounted for 44.2% (283), and those with lower TLC accounted for 68.0% (435). The patients with lower albumin and lower TLC had higher incidence of postoperative complications (13.3%), and higher mortalities at hospital (4.3%), 3-month (6.7%) and 12-month (16.7%) post-operatively compared to the patients who had normal values of the 2 laboratory parameters (all P＜0.05). Cox regression analysis indicated that serum ALB and TLC were predictive factors for mortality risk in the elderly with hip fracture. Conclusion Malnutrition at admission indicates poor clinical outcome after surgical treatment in the elderly patients with hip fracture. Lower serum ALB level and TLC are regarded as predictive factors for malnutrition and poor prognosis in these patients.