Cardiopulmonary exercise testing

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Pre-operative cardiopulmonary exercise testing for people in whom major abdominal surgery is planned.

Outcome of the appraisal


Cardiopulmonary exercise testing (CPET) shows promise when used to inform decision-making prior to major intra-abdominal surgery. The evidence shows that the use of CPET in addition to standard risk assessment improves the identification of patients at increased risk of surgery-related morbidity and mortality and facilitates the planning of peri-operative care. The evidence therefore partially supports the adoption of CPET for people undergoing major intra-abdominal surgery.


Further research is recommended to define the impact of CPET on clinical outcomes, patient experience and cost effectiveness as compared with standard risk assessment alone in people undergoing major intra-abdominal surgery.

Why was this topic appraised?


In people undergoing major intra-abdominal surgery, it is important to identify those that are at greatest risk of developing complications so that correct decisions about treatment can be made and management over the time of surgery optimized. Standard risk assessment includes the use of clinical information and simple testing information. Cardiopulmonary exercise testing (CPET) can be added to standard risk assessment to measure cardio-pulmonary fitness and reserve and thereby refine the decision-making process. Evidence supports the use of CPET to identify patients at greatest risk of death or serious complications when undergoing major intra-abdominal surgery and the additional information from CPET allows for the planning of care over the time of surgery.  There is less evidence available that defines the impact of using CPET on clinical outcomes, patient experience or the cost of surgery so further studies are recommended to clarify these issues.


The use of CPET before major abdominal surgery is increasing in NHS Wales, and Health Technology Wales appraised this topic to help inform the evidence-based use of this technology. This topic was submitted to Health Technology Wales by Dr Anthony Funnel, Consultant Anaesthetist, Cwm Taf Morgannwg University Health Board.

Plain language summary


Having major surgery causes the body to go through a stress response. This means that it uses more oxygen than usual and therefore needs more oxygen. How well a person is able to meet this extra demand can affect how well they are likely to recover from surgery. People who are physically fit are more likely to respond better to this demand, as their heart and lungs function better.

Cardiopulmonary exercise testing (CPET) is a way of measuring the performance of the heart and lungs at rest and when exercising. This will show how well the heart and lungs can respond to an increase in oxygen demand. It is suggested that these measurements can then be used to help plan a patient’s care in recovery.


Health Technology Wales looked for evidence that undertaking CPET can help predict how people will recover from major abdominal surgery. CPET is currently being used in a number of hospitals in Wales and there are a number of different measurements that can be taken during CPET. This evidence suggests that some CPET measurements can be used to help predict how a patient will recover from surgery, but reports of this vary across different types of surgery. There is little evidence available on what difference adding CPET to standard care makes.


The evidence therefore partially supports the adoption of CPET for people undergoing major intra-abdominal surgery, however further research is recommended

Topic Exploration Report

TER074 11.2019

Evidence Appraisal Review

EAR016 07.2020


GUI016 07.2020

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