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Are you “statistically significant”?

>For Patients >Preparing for your test

Are you fit to undergo surgery?  Wouldn’t it be good to know before you undergo that serious operation:

A major operation stresses the body in a similar way to any other big physical event – running a Marathon for example.  Few people would automatically consider themselves in peak condition for a Marathon, yet many undergo surgery without appropriate assessment.  Now a simple test taking less than an hour can confirm fitness for surgery, or point the way to the clinical regime which will minimise risk.  That test is a Cardio-pulmonary exercise test - or CPX for short.

Statistics released in July 2008 by the Department of Health demonstrated that survival rates within the NHS for certain operations could sometimes be three times worse than the national prediction¹.  These operations included some fairly commonplace procedures, for example on hips and knees.  The Department of Health insisted that the figures were "not statistically significant" because of the low numbers of patients involved!

What does a CPX test do?
Cardiopulmonary Exercise Testing (CPX) is a non-invasive way to assess the performance of the heart and lungs at rest and during exercise. For patients undergoing surgery, the performance of the heart and lungs is absolutely crucial. CPX testing identifies patients in a high risk group, generally associated with medical history, surgical history and fitness level.  By identifying a patient’s level of risk, specific treatment can be used to reduce that risk to the minimum possible, rather than waiting for complications to develop after surgery.  The test can also enable surgery where it might otherwise be considered too hazardous. CPX testing is safe and is performed in a medical environment, making it an ideal form of assessment.

What does the test involve?
A CPX test requires a short period of moderate exercise on an upright bicycle whilst breathing through a mouthpiece.  Each breath is measured to assess how the body is performing. The capacity and strength of the lungs is assessed before and during exercise.  Heart tracing (ECG) is also recorded prior to, during and post exercise.

The CPX test lasts for a total of 40 minutes, but patients are only required to exercise for approximately 10 minutes.  The amount of exercise is modest - it does not require exertion to maximum effort.  During the test patients are continuously monitored by the medical team.  Results are normally available within 24 hours of the consultation.

What information will be analysed during a CPX test?
The technical background to the test is a combination of the following tests:

The results of the test are vetted by highly qualified consultants and are always made available in report form to the treating surgeon.

Where can I have a CPX test?
Come to the Centre of Excellence! Our specialist team has extensive clinical experience and an established UK practice offering CPX medicine in the UK. We offer rapid testing (normally within 48 hours) at London Medical in the Harley Street area of London. The consultants offer an extensive scope of practice which incorporates the assessment of pre-operative patients, management of the critically ill, identification of previously undiagnosed cardiac conditions, and the titrating of fitness training. At London Medical, a CPX test is very accessible, professional, and available with or without medical referral.

What does CPX cost?
Remarkably little given the huge potential benefit!  The majority of insurance companies recognise CPX testing as an accredited method for cardiopulmonary assessment and as a result will cover most private patients for testing. CPX testing can also be sponsored by the NHS and this will need to be arranged via the referring Consultant. We are of course also happy to assess self pay patients.

Preparing for a test
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How to find out more
For further information or to book a CPX test email us or call 0207 636 9155

¹ Source; Death rates in some hospitals 'three times too high' - Daily Telegraph, 11th July 2008.  Statistics from the Department of Health.