Frailty and Early Extubation Independently Influence Postoperative Recovery Following Liver Transplantation—A Retrospective Cohort Study

Background Frailty and perioperative management critically influence outcomes following liver transplantation (LT). The liver frailty index (LFI) objectively assesses frailty, while early extubation (EE) has been linked to enhanced recovery in surgical patients. However, the associations of frailty and EE with postoperative outcomes in LT remain unclear. Methods This retrospective cohort study included adult LT recipients at a tertiary care center between 1/2019 and 7/2023. Patients were classified as frail (LFI ≥ 4.5) or nonfrail (LFI < 4.5) and stratified by EE versus delayed extubation (DE). Primary outcomes were EE rate, ICU length of stay (LOS), and hospital LOS. Linear regression models adjusted for age, gender, BMI, MELD, transplant type, and liver disease etiology. Results Of 158 postliver transplant patients, 38 (24.1%) were frail. Frail patients had longer ICU LOS (33.2 vs. 4.2 days, p < 0.001) and hospital LOS (59.5 vs. 10.1 days, p < 0.001) compared to nonfrail patients. EE occurred in 78.5% of all postliver transplant patients, with no significant difference by frailty ( p = 0.821). Multivariable regression showed frailty was associated with increased hospital LOS ( β = +48 days, 95% CI: 43–54, p < 0.001) and ICU LOS ( β = +28 days, 95% CI: 25–32, p < 0.001), while EE was associated with decreased hospital LOS ( β = −12 days, 95% CI: −17 to −6.7, p < 0.001) and ICU LOS ( β = −12 days, 95% CI: −15 to −8.4, p < 0.001), irrespective of frailty status. Conclusions Our study demonstrated that EE significantly shortens ICU and hospital stays in postliver transplant patients with pretransplant frailty. These findings underscore the importance of incorporating EE protocols in this high‐risk population and warrant further investigation into strategies that facilitate implementation to optimize clinical outcomes.