Pretransplant physical frailty, postoperative delirium, and short-term outcomes among older lung transplant recipients

Purpose: Delirium is a common, complex medical challenge that faces surgical patients in the postoperative period. Patients undergoing lung transplantation are at especially high risk given their predisposition to physical frailty and prolonged hospitalization. We sought to investigate the relationship between physical frailty, delirium, and short-term lung transplantation outcomes. Materials and methods: A retrospective study of adult patients who underwent lung transplantation was conducted. Pretransplant frailty markers, including the six-minute walk distance (6MWD) and short physical performance battery (SPPB), and postoperative outcomes, including the incidence of primary graft dysfunction (PGD) and the number of hospital free days alive in the 90-day interval following lung transplantation, were evaluated for association with delirium. Results: A total of 100 patients were included, 38% of whom experienced delirium. Greater pretransplant SPPB scores (indicating lower physical frailty) associated with a lower incidence of postoperative delirium. Postoperative delirium also associated with the number of hospital free days alive, independent of PGD. Conclusion: Pretransplant frailty is associated with greater incidence of postoperative delirium, which associated with fewer days alive outside of the hospital. Targeting frailty and postoperative delirium may be modifiable risk factors to improve short-term clinical outcomes.