Objective To construct a prediction model for postoperative healthcare-associated infection (HAI) in elderly patients with hip fracture, analyze the economic burden, provide a reference and basis for the development of clinical prevention and control programs. Methods 627 elderly patients who underwent hip fracture surgery in a hospital from January 1, 2017 to May 31, 2023 were selected as the study subjects. Patients were randomly divided into a modeling group and a validation group at a 7∶3 ratio. A logistic regression prediction model was constructed based on data from the modeling group, the discriminant and consistency of the model were evaluated by receiver ope- rating characteristic (ROC) curve and Hosmer-Lemeshow test, and the direct economic burden of postoperative HAI in patients was analyzed with 1∶1 propensity score matching (PSM). Results The incidence of postoperative HAI in elderly patients with hip fracture surgery was 12.1%, with pulmonary infection being the most common (52.6%). Logistic regression analysis showed that male, old age, perioperative disturbance of consciousness, grade Ⅳ of American Society of Anesthesiologists (ASA) classification, low albumin level, and intensive care unit (ICU) admission were all independent risk factors for postoperative HAI in patients (all P<0.05). There was good model discrimination and consistency between the training and validation groups in predicting the risk of postoperative HAI. The direct economic burden of postoperative HAI in patients was 7 927.4 Yuan, of which the burden of wes-tern medicine was the largest (3 139.7 Yuan). HAI prolonged patients hospitalization time by 3.6 days. Conclusion Postoperative HAI increases the economic burden of patients, the nomogram model constructed in this study can effectively predict the risk of postoperative HAI in patients, which can provide a basis for the early identification, as well as the implementation of targeted preventive and diagnostic measures for high-risk patients in the clinic.