Twenty-Hospital IMSS Registry Tracks Hip Fracture Care Gaps in 2024

A registry spanning twenty hospitals of the Instituto Mexicano del Seguro Social (IMSS) has documented how hip fracture patients fared within the social security health system in 2024, and the picture is one of partial progress shadowed by persistent structural shortcomings. The report, published in Archives of Osteoporosis, followed 1,095 patients and found an in-hospital mortality rate of 2.6 percent, but also revealed that only 8.6 percent of patients underwent surgery within the registry’s 36-hour goal, and that more than two thirds were lost to follow-up within a month of discharge.

Hip fracture is a major cause of morbidity and mortality that entails high costs for the healthcare system, and the number of cases is expected to increase in the coming years. The IMSS registry was designed as an observational, multicenter, longitudinal and descriptive study to measure how well care standards are being met across a network of hospitals. Twenty facilities participated, with data recorded on hospital stay, epidemiological characteristics and clinical management, and follow-up planned at 30 and 120 days after discharge. Data were analyzed using SPSS version 22.0.

The median age of enrolled patients was 79 years, with an interquartile range of 74 to 85, and women made up 71.8 percent of the cohort, numbering 786 individuals. The vast majority, 1,009 patients or 92.1 percent, came from the community rather than institutional care, and most were autonomous before the fracture, with a median Barthel index score of 90 points, indicating substantial independence in daily activities prior to injury.

Fracture type and perioperative care varied. Pertrochanteric fractures were the most common, accounting for 52.3 percent of cases with 573 patients. Thromboprophylaxis to prevent venous thromboembolism was administered to 84.8 percent of patients, while antibiotic prophylaxis reached 50.7 percent, a figure that highlights uneven adherence to infection-prevention practices across the network.

The most striking finding concerns surgical timing. The registry set a 36-hour goal for surgery, yet only 94 patients, or 8.6 percent, met that target. The mean time from emergency room arrival to the surgical procedure was 6.6 days, with a standard deviation of 6.3 days. The most frequently cited cause of delay was scheduling, implicated in 75.3 percent of cases, suggesting that the bottleneck lies less in clinical readiness than in the organization of surgical services.

Delays began even before hospital care. The mean time from injury to transfer to the emergency department was 88.2 hours, though with a very large standard deviation of 197 hours, indicating that some patients reached hospital care quickly while others waited days. Once in the emergency department, patients spent a median of 24 hours there, with an interquartile range of 9 to 47 hours, before moving onward in the care pathway.

Mortality figures were comparatively encouraging. Acute in-hospital mortality stood at 2.6 percent, corresponding to 28 deaths among the 1,095 patients. Among those who could be assessed after discharge, mortality was 7.6 percent at 30 days, based on 24 deaths, and 7.4 percent at 120 days, based on 15 deaths among patients assessed at the earlier time point. These figures, however, must be read alongside the follow-up data, because the denominators shrank dramatically over time.

Loss to follow-up emerged as one of the registry’s most sobering results. At 30 days after discharge, 754 patients, or 70.6 percent, could not be reached. Of those who had been assessed at 30 days, a further 87 patients, or 30.1 percent, were lost by the 120-day assessment. This attrition means the later mortality figures describe only a small, potentially unrepresentative subset of survivors, and it also signals a gap in continuity of care for a population at high risk of complications and death.

Secondary prevention at discharge was documented in 65.3 percent of patients, or 715 individuals. While this represents a majority, it leaves roughly one in three patients discharged without a documented secondary prevention strategy.

The authors conclude that there was a slight improvement in standards of care in hip fracture compared with the previous year’s registry, but that improvements are required in specific areas. The data point to surgical scheduling, prophylaxis practices, secondary prevention at discharge and post-discharge follow-up as the areas where the gaps are widest. As populations age and the number of hip fractures is expected to rise in the coming years, the registry’s role in tracking these standards is likely to grow in importance for the health system.

Subject of Research: A 2024 multicenter hip fracture care registry across twenty IMSS hospitals in Mexico

Article Title: “IMSS Multicenter Hip Fracture Registry Report: 2024”

Article References: Octavio, D.-F. J., Alonso, C.-S. J., Sergio, S.-G., Georgina, C.-F. S., Eduardo, M.-F. H., Eduardo, P.-M. E., Nitza, P.-M., Andrés, G.-L., Angélica, G.-M. G., Evelia, P.-L., Alicia, G.-C. M., Yuridia, O.-G., Ivan, L.-H., Patricia, R.-F. Y., Alberto, B.-G. C., Cristina, Y.-G., Guadalupe, L.-H. G., Daniela, M.-H. B., Jesus, S.-A. C., … Humberto, M.-C. J. (2026). “IMSS Multicenter Hip Fracture Registry Report: 2024”. Archives of Osteoporosis, 21(1), 150. https://doi.org/10.1007/s11657-026-01794-7

Image Credits: AI Generated

DOI: 10.1007/s11657-026-01794-7

Keywords: hip fracture, osteoporosis, IMSS, Mexico, surgical delay, mortality, follow-up loss, secondary prevention, geriatric trauma, registry study, thromboprophylaxis, emergency department