Perioperative risk assessment using cardiopulmonary exercise testing: supporting shared decision-making and prehabilitation

For patients undergoing major surgery, the pathway through treatment and recovery can be uncertain. The age and multimorbidity of surgical patients are increasing, with an estimated one in eight patients presenting for surgery with multiple coexisting health conditions1. Multimorbidity has been shown to worsen postoperative outcomes, worsen quality of life, and increase healthcare usage over time2. Consequently, accurate and validated screening and assessment tools to aid risk stratification through the perioperative interval are increasingly important. CPET is an objective assessment method of evaluating a patient’s individual physical fitness before surgery. It is estimated that >30 000 cardiopulmonary exercise tests are conducted each year in England and this assessment modality has gained popularity in recent years as it offers significant prognostic value for a patient’s morbidity and mortality after surgery3,4. Research shows that patients with higher physical fitness at the time of CPET recover sooner, experience fewer postoperative complications, and have an improved ability to be rescued if complications occur4,5.