Cardiopulmonary exercise testing (CPET) in the United Kingdom—a national survey of the structure, conduct, interpretation and funding

Abstract

BackgroundCardiopulmonary exercise testing (CPET) is an exercise stress test with concomitant expired gas analysis that provides an objective, non-invasive measure of functional capacity under stress. CPET-derived variables predict postoperative morbidity and mortality after major abdominal and thoracic surgery. Two previous surveys have reported increasing utilisation of CPET preoperatively in England. We aimed to evaluate current CPET practice in the UK, to identify who performs CPET, how it is performed, how the data generated are used and the funding models.MethodsAll anaesthetic departments in trusts with adult elective surgery in the UK were contacted by telephone to obtain contacts for their pre-assessment and CPET service leads. An online survey was sent to all leads between November 2016 and March 2017.ResultsThe response rate to the online survey was 73.1% (144/197) with 68.1% (98/144) reporting an established clinical service and 3.5% (5/144) setting up a service. Approximately 30,000 tests are performed a year with 93.0% (80/86) using cycle ergometry. Colorectal surgical patients are the most frequently tested (89.5%, 77/86). The majority of tests are performed and interpreted by anaesthetists. There is variability in the methods of interpretation and reporting of CPET and limited external validation of results.ConclusionsThis survey has identified the continued expansion of perioperative CPET services in the UK which have doubled since 2011. The vast majority of CPET tests are performed and reported by anaesthetists. It has highlighted variation in practice and a lack of standardised reporting implying a need for practice guidelines and standardised training to ensure high-quality data to inform perioperative decision making.

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

“…CPET provides an objective assessment of physical fitness through evaluating cardio‐respiratory function under the stress of exercise mimicking the stress of major surgery. This has been widely adopted in the UK as a preoperative test to objectively evaluate perioperative risk, and international guidelines for CPET conduct have recently been published . The ability of CPET to identify patients at risk of poor outcomes is used clinically to guide perioperative care and clinical decision making, and it informs about the shared decision‐making process .…”

Cardiopulmonary exercise testing—a beginner’s guide to the nine-panel plot

“…Matrix codes: 1A01, 2A03, 3I00 urology, and thoracic surgeries. 6 CPET is also used extensively outside the UK, particularly in cardiology, respiratory medicine, and preoperative assessment. CPX International is a society that promotes the use of CPET worldwide.…”

Cardiorespiratory fitness is impaired and predicts mid‐term postoperative survival in patients with abdominal aortic aneurysm disease

“…However, in order to demonstrate an improved ability to identify high-risk patients, PCPET values should also be compared against, or in conjunction with, other risk prediction models, such as the Revised Cardiac Risk Index (RCRI), Physiological and Operative Score for enumeration of Mortality and Morbidity (POSSUM), National Surgical Quality Improvement Program (NSQIP) and Surgical Outcome Risk Tool (SORT) (Reeves et al, 2018). However, in order to demonstrate an improved ability to identify high-risk patients, PCPET values should also be compared against, or in conjunction with, other risk prediction models, such as the Revised Cardiac Risk Index (RCRI), Physiological and Operative Score for enumeration of Mortality and Morbidity (POSSUM), National Surgical Quality Improvement Program (NSQIP) and Surgical Outcome Risk Tool (SORT) (Reeves et al, 2018).…”

“…We have reported an association between PCPET and mid-term postoperative survival. However, in order to demonstrate an improved ability to identify high-risk patients, PCPET values should also be compared against, or in conjunction with, other risk prediction models, such as the Revised Cardiac Risk Index (RCRI), Physiological and Operative Score for enumeration of Mortality and Morbidity (POSSUM), National Surgical Quality Improvement Program (NSQIP) and Surgical Outcome Risk Tool (SORT) (Reeves et al, 2018).…”