Abstract：[Objective] To investigate the factors of delayed surgery for femoral intertrochanteric fracture in the elderly within 72 hours after admission. [Methods] The clinical data of 144 elderly patients with intertrochanteric fractures who underwent hip replacement combined with internal fixation to reconstruct the greater trochanter from October 2018 to February 2022 were retrospectively analyzed. The potential factors affecting the operation such as age, gender, drinking history, smoking history, diabetes, hypertension, urinary tract infection, arrhythmia, pulmonary infection, ASA classification, preoperative test and preoperative examination were recorded. The patients were divided into delayed group and non-delayed group according to whether the operation was completed within 72 hours after admission. Single factor comparison and binary multivariate logistic regression analysis were used to search the factors of delayed surgery. [Results] Among 144 patients, 111 cases (77.08%) had delayed surgery. Univariate analysis showed that compared with the non-delayed group, the delayed group had a significantly younger age, a significantly higher preoperative alanine aminotransferase level, and a significantly higher proportion of patients with arrhythmia, urinary tract infection, and pulmonary infection (P < 0.05). Multivariate logistic regression analysis showed that: Age (OR=0.906, P=0.026) was a protective factor for delayed surgery for elderly patients with intertrochanteric fracture. Arrhythmia (OR=9.383, P=0.035) and pulmonary infection (OR=7.342, P=0.012) were independent risk factors for delayed surgery for elderly patients with intertrochanteric fracture. [Conclusion] Arrhythmia and pulmonary infection are risk factors for delayed surgery within 72 hours after admission in elderly patients with femoral intertrochanteric fractures, and age is a protective factor.