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.