Fitness testing to support patients’ surgery decisions
Major surgery is a life-changing event. Those deciding whether to go ahead need to be clear about the risks and benefits. Our research has shown fitness tests can predict the risks and outcomes from surgery.
We pioneered the use of cardiopulmonary exercise testing (CPET) to measure fitness before surgery.
We linked CPET fitness scores before surgery with the risk of complications or death after surgery.
Based on our results, more than two thirds of UK hospitals now use CPET testing before surgery.
Testing fitness before surgery
Cardiopulmonary exercise testing (CPET) measures fitness accurately. We pioneered the use of CPET before surgery.
We have led many studies in different types of surgery, including the first large study with data from several hospitals. We linked CPET fitness scores before surgery with the risk of complications or death after surgery (published here). The fitness scores also predicted quality of life after surgery.
Providing a personalised estimate
CPET scores provide a personal estimate of risk, that can help a patient to decide whether to go ahead with surgery or not.
The CPET scores can also be used to prescribe a personalized exercise program to get fit for surgery. Finally, the CPET test can help diagnose or improve the treatment of other heart or lung conditions that can affect recovery from surgery.
We have explored how fitness affects risk. We were the first to show that muscle mass and quality (sarcopenia) affect CPET scores (published here). We then showed that fitness was more important than the mass of muscle in predicting outcome.
We also found that the mass of haemoglobin (which carries oxygen in the blood) in patients affects their fitness (published here).
Influencing hospitals nationally
Based on these results, more than two thirds of UK hospitals now use CPET testing before surgery.
Our group has also led training and professional standards in CPET. We have delivered more than 25 UK and overseas courses. We also developed a formal qualification for CPET testers.
Working with clinical colleagues worldwide, we led the international CPET guidelines. Based on agreed evidence, these guide surgeons and healthcare professionals using CPET.
Finally, six of our group contributed to the “Pre-operative Assessment and Optimisation for Adult Surgery (Post COVID-19)” national guidance about preparing patients for surgery.
What do we plan to do next?
Over 2022-27, we will use our expertise to add CPET scores into computer models that combine lots of data to give a personalized estimate of risk.
We plan to test whether exercise training improves recovery from surgery. We will also explore how giving iron and mitochondria (the cell’s powerhouse) affect fitness.