Patients who experience fragility hip fractures are at high risk for delirium. However, little is known about changes in health resource utilization associated with this adverse event. The objectives of this work were to quantify the difference in episode of care costs and length of stay from the hospital perspective between patients who do and do not experience perioperative delirium. Patient care data from a single centre were linked with micro-case costing reports. Propensity matching and regression modeling were used to control for potential confounders. Delirium was found to be associated with significant incremental episode of care costs and length of stay. The difference in costs was partly, but not fully, explained by differences in length of stay. Future work should focus on confirming the generalizability of these findings, assessing the impact using broader economic perspectives, and implementing cost-effective interventions to reduce the rate of perioperative delirium in this population.