Association between frailty and postoperative delirium after transcatheter aortic valve replacement: a meta-analysis

Background Postoperative 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. Methods A 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. Results Ten 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; I 2 = 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). Conclusions Frailty 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 registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420261352173.