ArticleBMJ open2026
Timing of surgical intervention following traumatic femoral fractures in Northern Tanzania: a hospital-based retrospective cohort study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesDelayed surgical fixation of femoral fractures is associated with increased morbidity and mortality; however, delays remain common in low-income and middle-income countries. This study aimed to determine time to surgery and identify factors associated with time to surgery among patients with traumatic femoral fractures at a tertiary referral hospital in northern Tanzania.
designRetrospective cohort study using routinely collected data.
settingKilimanjaro Christian Medical Centre, a zonal referral hospital in northern Tanzania.
participants2040 patients with traumatic femoral fractures treated surgically between January 2018 and December 2024. Patients with pathological fractures, femoral neck fractures treated with total hip replacement, prior femoral fractures, revision surgeries or spinal cord injuries were excluded. OUTCOME MEASURE: The primary outcome was time to surgery, defined as the number of days from injury to surgery. Weibull proportional hazards regression models were used to identify predictors of time to surgery, with directed acyclic graphs informing covariate selection. We examined 11 pre-specified factors potentially associated with time to surgery, including health insurance, co-morbidities, haemoglobin level (g/dL), associated injuries, American Society of Anesthesiologists (ASA) class, fracture location, fracture morphology, fracture status, implant type, mode of implant application and anaesthesia type.
resultsThe median (IQR) time to surgery among 2040 patients was 14 (7-24) days. Of the 11 factors examined, 7 were associated with time to surgery, 2 had no clear association and 2 showed no evidence of an association. Factors associated with shorter time to surgery included health insurance coverage (HR 1.83, 95% CI 1.71 to 1.96), higher haemoglobin levels (HR per unit increase, 1.02, 95% CI 1.01 to 1.04), middle and distal fracture locations, simpler fracture morphology and specific implant types. Factors associated with longer delays included associated injuries (HR 0.87, 95% CI 0.79 to 0.96), open fractures (HR 0.82, 95% CI 0.71 to 0.95) and higher ASA classes (HR range 0.64-0.88 for classes II-IV).
conclusionsTime to surgical fixation following femoral fractures was prolonged, with a median delay of 14 days. This study identified factors that may be related to surgical timing, although causality could not be firmly demonstrated. Interventions aimed at improving financial access to care and perioperative optimisation may reduce delays in this setting.
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