Cardiopulmonary Exercise Testing and Preoperative Risk Stratification (CPX or CPEX)

• Postoperative morbidity (presence or absence of POMS defined morbidity) [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
  

• Post operative morbidity domains e.g. gastrointestinal, renal, pulmonary [ Time Frame: Day 5 ] [ Designated as safety issue: No ]
  
• Total postoperative ITU bed utilisation [ Time Frame: End of hospital stay i.e. day of hospital discharge ] [ Designated as safety issue: No ]
  
• Total postoperative bed utilisation [ Time Frame: End of hospital stay i.e. day of hospital discharge ] [ Designated as safety issue: No ]
  
• ITU re-admission [ Time Frame: End of hospital stay i.e. day of hospital discharge ] [ Designated as safety issue: No ]
  
• Death [ Time Frame: Should death occur ] [ Designated as safety issue: No ]
  
• SF36 (compared with SF36 at baseline) [ Time Frame: 12 months post day of surgery ] [ Designated as safety issue: No ]
  

Each year 20000 UK patients die within 30 days of surgery. It seems that in the UK a patient's chances of becoming seriously unwell or dying following surgery is higher than in comparable countries. Fewer beds in the UK are given over to Intensive Care than in these other countries. Closer attention to the care given after operations, which can be achieved on intensive care units (ICU), almost certainly reduces the chances of serious illness following major surgery. An increase in the number of intensive care unit beds in the UK is extremely unlikely. Better use of the available intensive care beds could be achieved by allocating them where they are believed to improve outcome (following surgery) and by allocating them to patients most likely to benefit.

Tests used to assess risk of surgery to patients are largely ineffective. Cardiopulmonary exercise tests (CPX) seem to be effective at identifying patients at risk of death or serious illness post surgery. This information has been used in studies to select patients for ICU beds and reduce deaths. The studies so far have limitations in their design and scope which means we can't be certain this approach works in the UK.

We suggest a study to answer this question more conclusively and more specifically in UK patients. We will randomly divide patients between two groups. In the 1st group choice of postoperative care environment is based on best current practice and in the other group we will make these decisions (critical care or ward) based on the results of the CPX.

We hope that the benefits will include less patients becoming seriously ill or dying and shorter stays in hospital after surgery following major operations. We also hope the information will help patients understand the risks of their operation better and therefore make better informed decisions. This may also reduce the overall cost of surgery for hospitals.

As a secondary goal we would also like to assess whether a pre-operative blood test of a heart hormone called B type natriuretic peptide (BNP) can predict heart damage after major surgery.