Cardiopulmonary Exercise Variables Are Associated With Postoperative Morbidity After Major Colorectal Surgery - A Validation Study

Patients in all the centres (Aintree University Hospitals NHS Foundation Trust, University Hospital Crosshouse NHS Foundation Trust, Barts Healthcare NHS Foundation Trust, East Kent Hospitals University NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, South Devon Healthcare NHS Foundation Trust and Maidstone and Tunbridge Wells NHS Trust) will undergo a maximal CPET prior to major colorectal surgery (defined as a procedure involving bowel resection +/- an anastomosis or stoma) according to the CPET protocol defined in Appendix 1. If the CPET deviates from this protocol, the centre would need to clear their local CPET protocol with the Principle Investigator (PI). All variables measured by CPET which will be collected are outlined in Appendix 2.

Following the CPET, patients will undergo a major colorectal surgical procedure. Following surgery only routine clinically relevant observational data will be collected. These data will relate to hospital length of stay, the level of care required following surgery, post-operative morbidity (Postoperative Morbidity Survey - POMS and Clavine Dindo Score) and the recovery process. Most of this information can be accessed from prospectively maintained enhanced recovery databases, however patient notes and electronic patient records are acceptable alternatives. Appendix 2 shows the minimum dataset that will be collected.

All data from each individual hospital will be anonymized at source and the PI will only be sent CPET variables, post-operative outcome data, and basic patient demographics (outlined in Appendix 2) which cannot be linked back to the original patient.

We aim to include all patients aged >18 years considered for major colorectal surgery (benign or malignant) and undergoing an enhanced recovery programme after surgery. Patients will be excluded if they have diagnosis of inflammatory bowel disease, patients scheduled for neoadjuvant cancer therapy, patients physically unable to perform a CPET on a cycle ergometer, patients having no surgery performed or interim emergency surgery, patients lacking complete in-hospital morbidity data. All patients received an information sheet regarding CPET and written consent for the CPET as part of their routine care was obtained at each centre.

Hypothesis