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Frailty, marked by reduced physiological resilience, is associated with adverse outcomes in patients undergoing various cardiovascular procedures. The rising incidence of cardiac implantable electronic device (CIED) infections necessitate transvenous lead removal (TLR), yet the impact of frailty on TLR outcomes remains unclear.

The purpose of this study was to evaluate the association between frailty and outcomes in patients undergoing TLR for CIED infections.

This retrospective study analyzed the National Readmissions Database (2016–2021) for patients hospitalized with CIED infections who underwent TLR, identified using International Classification of Diseases, Tenth Revision codes. Frailty was defined using Johns Hopkins frailty-defining diagnoses. Outcomes, including in-hospital mortality, procedural complications, discharge disposition, length of stay, and 30-, 90-, and 180-day readmissions, were compared between frail and nonfrail patients by using multivariable logistic regression.

Of the 44,370 patients undergoing TLR, 10,116 (22.8%) were frail. Frail patients were older (69.8 years vs 66.4 years) with higher comorbidity burden and systemic infections (6707 (66.3%) vs 16,202 (47.3%)) (P < .01). Frailty was independently associated with higher in-hospital mortality (1224 (12.1%) vs 1713 (5.0%); adjusted odds ratio 1.95; 95% confidence interval 1.74–2.21) and periprocedural complications, including cardiac arrest, pulmonary complications, and longer hospital stays. Frail patients had higher rates of non–home discharge and higher readmissions at 30, 90, and 180 days (P < .01 for all). Malnutrition and decubitus ulcers were strongly associated with mortality.

Frailty is a key predictor of adverse outcomes in TLR for CIED infections. Preoperative frailty assessment and tailored management strategies are essential to mitigate risks in this high-risk population.