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

Perioper Med (Lond). 2018 Jan 26;7:2. doi: 10.1186/s13741-017-0082-3. eCollection

Reeves T, Bates S, Sharp T, Richardson K,
Bali S, Plumb J, Anderson H, Prentis J, Swart,
Levett DZH; Perioperative Exercise Testing and Training Society

Background: Cardiopulmonary 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.
Methods: All 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.
Results: The 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.
Conclusions: This 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.