Cardiovascular-Kidney-Metabolic (CKM) syndrome staging as a unified predictor of morbidity and mortality following pancreatic resection: A national cohort analysis.

BACKGROUND

Pancreatic resection is a profound physiologic stress test. Traditional risk assessment often focuses on procedure-specific technical failures, yet postoperative recovery depends heavily on a patient's systemic physiologic reserve. We evaluated the association between the American Heart Association's Cardiovascular-Kidney-Metabolic (CKM) syndrome framework and outcomes following pancreatic resection.

METHODS

This retrospective study utilized the National Inpatient Sample to identify patients undergoing pancreatectomy. Patients were stratified into three CKM stages (0/1, 2/3, and 4a/4b) using ICD-10-CM proxies. Primary outcomes included in-hospital mortality and major morbidity (Clavien-Dindo grade ≥ III); failure-to-rescue after systemic complications was evaluated as a secondary outcome.

RESULTS

Among 1162 patients, 22.9% were classified as CKM Stage 4a/4b. Systemic complications escalated significantly with advancing CKM stage, while the surgical/technical complication composite did not differ significantly across stages. CKM Stage 4a/4b was independently associated with major postoperative morbidity (aOR 2.63; 95% CI 1.71-4.05; P < .001) and prolonged length of stay (aOR 2.03; 95% CI 1.30-3.17; P = .002), but not in-hospital mortality (aOR 0.55; 95% CI 0.23-1.32; P = .182). Failure-to-rescue was not higher in CKM Stage 4a/4b after adjustment (aOR 0.47; 95% CI 0.20-1.08; P = .075).

CONCLUSION

CKM staging identifies a clinically meaningful gradient of systemic vulnerability. Advanced CKM burden predicts major morbidity and high resource utilization, without an independent increase in in-hospital mortality or failure-to-rescue.