Systematic review and meta-analysis on frailty and delirium after TAVR

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Frontiers in Medicine Published May 21, 2026 Medically reviewed May 21, 2026 DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider frailty assessment for delirium risk stratification in TAVR patients, based on associative evidence.

This is a systematic review and meta-analysis of studies assessing the association between preprocedural frailty and postoperative delirium in patients undergoing transcatheter aortic valve replacement. The analysis included 7,702 patients, with 2,062 (26.8%) having frailty and 786 (10.2%) developing delirium.

The authors synthesized evidence showing that frailty was significantly associated with an increased risk of postoperative delirium, with a pooled odds ratio of 2.17 (95% CI: 1.60–2.95). Subgroup analyses indicated a stronger association in studies with sample sizes of 500 or more (OR: 2.74) compared to smaller studies (OR: 1.38), with a significant subgroup difference (p < 0.001). The association was also stronger in studies using the CAM-ICU method (OR: 3.60) versus DSM criteria (OR: 1.56) or other methods (OR: 2.53; p = 0.006).

The authors noted significant heterogeneity (I2 = 55%), with sample size identified as a significant source (p = 0.02). Limitations include the observational nature of the included studies, which precludes causal inference. The review did not report safety data or adverse events.

Practice relevance is limited to highlighting the importance of frailty assessment for perioperative risk stratification and supporting targeted strategies to prevent delirium in high-risk TAVR patients. The evidence is associative, not causal.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundPostoperative delirium (POD) is a common complication following transcatheter aortic valve replacement (TAVR) and is associated with adverse outcomes in older patients. Frailty, a multidimensional geriatric syndrome, has been increasingly recognized as a potential risk factor for POD. However, existing evidence remains inconsistent. This meta-analysis aimed to evaluate the association between frailty and POD after TAVR.MethodsA systematic search of PubMed, Embase, and Web of Science was conducted from inception to January 22, 2026. Cohort studies evaluating the association between preprocedural frailty and POD after TAVR were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model accounting for the influence of potential heterogeneity.ResultsTen cohort studies involving 7,702 patients were included. Frailty was present in 2,062 (26.8%) patients, and 786 (10.2%) developed POD. Pooled analysis showed that frailty was significantly associated with an increased risk of POD after TAVR (OR: 2.17, 95% CI: 1.60–2.95; I2 = 55%). The association was stronger in studies with sample size ≥ 500 compared with < 500 (OR: 2.74 vs. 1.38; p for subgroup difference < 0.001). The effect estimates were consistent across subgroups stratified by study design, age, sex, frailty assessment methods, follow-up duration, analytic models, and study quality (all p for subgroup difference > 0.05). Notably, studies using CAM-ICU to diagnose POD showed a stronger association than those using DSM criteria or other methods (OR: 3.60 vs. 1.56 and 2.53; p = 0.006). Meta-regression identified sample size as a significant source of heterogeneity (p = 0.02).ConclusionsFrailty is associated with an increased risk of POD after TAVR. These findings highlight the importance of frailty assessment for perioperative risk stratification and support targeted strategies to prevent delirium in high-risk patients undergoing TAVR.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261352173.