Abstract
Aims:
Hip fractures are an emerging public health challenge in Africa. Data on surgical outcomes and health-related quality of life (HRQoL) are important to inform service delivery but are scarce. We aimed to characterise perioperative care, complications, and determine associations between the presence of complications and HRQoL among patients undergoing hip fracture in Zimbabwe.
Methods:
This prospective cohort study enrolled patients aged ≥40 years with a surgically managed hip fracture in either of the two public or five-private hospitals in Harare, between October 2021 and October 2022. Patients were followed-up for 12-months. Outcomes included complications, disability and HRQoL measured using the WHODAS and EQ-5D instruments. Concordance with surgical guidelines and differences between public and private sector care were also evaluated. Trajectories of EQ-5D utility scores were estimated using non-linear mixed-effects models.
Results:
Of 116 patients, 59.5% were age ≥70 years and 47.9%(n=57) were female. Most (82.8%) were treated in public hospitals. Median time from injury to surgery was 25 days (IQR:10–45) including a median 16 days (IQR:8-27) between admission and surgery (with marked differences by hospital type (public: 20 days (10-30) vs. private: 4 days (2-7.5);p<0.001). Postoperative stays were short [median 3 (IQR:2-6) days].
Over half (55.2%) experienced one or more complications, most commonly pressure sores (24.1%), surgical site infection (22.9%) and delirium (9.5%). Prolonged admission (≥19 days) [OR=3.0;95%CI:1.15,7.81], delayed surgery (≥16 days after admission) [OR=2.46; 95%CI:1.16,5.21], and female sex [OR=2.96;95%CI:1.20, 7.30], were associated with complications in univariate analyses. Patients with complications reported lower HRQoL [β=-0.04; 95%CI:-0.07,-0.003] throughout follow-up.
Conclusion:
Patients with hip fracture in Zimbabwe experience long delays to surgery and high complication rates, particularly in public hospitals. Poorer outcomes were strongly associated with surgical delay. Standardising care delivery, reducing time to surgery, and expanding post-discharge care, are essential to improve outcomes
Hip fractures are an emerging public health challenge in Africa. Data on surgical outcomes and health-related quality of life (HRQoL) are important to inform service delivery but are scarce. We aimed to characterise perioperative care, complications, and determine associations between the presence of complications and HRQoL among patients undergoing hip fracture in Zimbabwe.
Methods:
This prospective cohort study enrolled patients aged ≥40 years with a surgically managed hip fracture in either of the two public or five-private hospitals in Harare, between October 2021 and October 2022. Patients were followed-up for 12-months. Outcomes included complications, disability and HRQoL measured using the WHODAS and EQ-5D instruments. Concordance with surgical guidelines and differences between public and private sector care were also evaluated. Trajectories of EQ-5D utility scores were estimated using non-linear mixed-effects models.
Results:
Of 116 patients, 59.5% were age ≥70 years and 47.9%(n=57) were female. Most (82.8%) were treated in public hospitals. Median time from injury to surgery was 25 days (IQR:10–45) including a median 16 days (IQR:8-27) between admission and surgery (with marked differences by hospital type (public: 20 days (10-30) vs. private: 4 days (2-7.5);p<0.001). Postoperative stays were short [median 3 (IQR:2-6) days].
Over half (55.2%) experienced one or more complications, most commonly pressure sores (24.1%), surgical site infection (22.9%) and delirium (9.5%). Prolonged admission (≥19 days) [OR=3.0;95%CI:1.15,7.81], delayed surgery (≥16 days after admission) [OR=2.46; 95%CI:1.16,5.21], and female sex [OR=2.96;95%CI:1.20, 7.30], were associated with complications in univariate analyses. Patients with complications reported lower HRQoL [β=-0.04; 95%CI:-0.07,-0.003] throughout follow-up.
Conclusion:
Patients with hip fracture in Zimbabwe experience long delays to surgery and high complication rates, particularly in public hospitals. Poorer outcomes were strongly associated with surgical delay. Standardising care delivery, reducing time to surgery, and expanding post-discharge care, are essential to improve outcomes
| Original language | English |
|---|---|
| Journal | Bone and Joint Journal |
| Publication status | Accepted/In press - 19 Feb 2026 |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
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