Preoperative cardiopulmonary exercise testing: physiological basis and investigation

The number of cardiopulmonary exercise testing (CPET) centres has doubled in the UK since 2011. Approximately 30,000 tests are performed every year in the UK now. It is a useful tool helping preoperative risk stratification. Patients with poor exercise tolerance are more likely to suffer perioperative complications and death. Interpretation of a large amount of data generated during the test requires a good understanding of basic exercise physiology and its clinical application. Incorporation of CPET data in a global preoperative assessment provides a personalized risk estimate for a patient. This risk estimate discussed with the multidisciplinary team and the patient is an opportunity to make a decision which is in the patient's best interest. Such decisions also help in the best use of healthcare resources. Newer studies in this field are addressing the ongoing debate about the future use of CPET-derived parameters.