Cardiopulmonary exercise testing (CPX)

Despite the best efforts, in the best hospitals, surgery and anaesthesia carries a risk. If the patient is fit or the surgery is minor, the risk is often so small that it is less than the risk of crossing the road or travelling by plane. But in the elderly or those with medical illnesses, the risk rises, as it does with major surgery.

 

At The London Clinic two major advances have occurred in the care of high risk patients; they can now be identified by a simple outpatient test, and special treatment can be performed before surgery to reduce risk substantially.

 

The test involved is called Cardiopulmonary Exercise testing (CPX), and the Clinic is the first centre in the UK to offer this assessment. CPX involves modest exercise on an upright bicycle, with the performance of the heart and lungs assessed. CPX measures the point when exercise becomes anaerobic, and if this measurement is reduced, operative risk is high.

 

When a high risk patient is identified, lifesaving techniques developed in intensive care medicine are used to optimise the breathing and circulation prior to surgery.

 

CPX is a non-invasive measurement and is a well-tolerated procedure that most patients scheduled for elective surgery can perform easily. CPX will reduce mortality associated with major surgery and will also reduce complications and the overall length of stay in hospital.

 

Uniquely, CPX is now available for outpatients at The London Clinic. The Clinical Assessment Unit is run by Dr John Goldstone and closely co-ordinates the pre-operative assessment of patients and pre-admission to the Critical Care Unit if treatment before surgery is required. This offers a seamless assessment and treatment program for the high-risk surgical patient at The London Clinic.

 

This type of cardio respiratory testing has broader applications; from assessing people with cardio respiratory disease to pre-surgery risk stratification, athletic assessments and health screening.

 

The CPX service is situated at The London Clinic Consulting Rooms and Outpatient Centre at 5 Devonshire Place.

 

This test takes approximately 60 minutes to perform and the results, provided by the Intensive Care / Anaesthetist, are generally available within 48 hours.

 

Why book a patient for CPX?

 

- We are the first independent hospital within the UK to launch this valuable

  service
- This service has been calibrated extensively on a large cohort of volunteers and

  has been carefully set up
- CPX has been shown to reduce mortality associated with major surgery and the

  overall length of stay in hospital
- As a consequence of the results of CPX you may be given the go-ahead for your

  patient to undergo surgery, advice may be given to make the patient fit for

  surgery or the patient may be advised to not undergo the surgery. CPX aids the

  clinical decision making process and reduces clinical risk associated with major

  surgery.

 

Payment for CPX

 

In the case of a patient with medical insurance they are advised to check with their medical insurer that their policy covers this outpatient test. The test is reimbursed currently by BUPA and AXA-PPP for patients having treatment at The London Clinic. This is agreed on the criteria below:

- Previous severe cardio-respiratory disease
- Late stage Vascular disease
- Age > 70 years with limited physiological reserve in one or more vital organs
- Extensive surgery for carcinoma
- Acute abdominal surgery with haemodynamic instability
- Acute massive blood loss
- Septicaemia
- Positive blood culture or septic focus
- Respiratory failure
- Acute Hepatic or Renal failure

 

If patients are having their treatment at any other private hospital they will have to pay for the cost of the CPX test personally.

 

For embassy-sponsored patients a letter of guarantee will be required, to be presented at health screening on the day of the procedure.

 

Self-pay patients can pay at the health screening reception in advance or on the day of the procedure.

 

 

CPX frequently asked questions

 

 

Our experts     

 

Contact details                                                                  

 

 

 

For bookings, further information or to speak to Dr Goldstone please contact        

 

Telephone    

 

Fax a request for a time & date for your patient         

 

Clinical Director Critical Care Unit

 

The CPX service is an integral part of health screening and is situated on the ground floor at 5 Devonshire Place

 

Sally Dadds

 

 

020 7636 9155

 

020 7636 9237

 

You will need to include an email/fax number and your name and title and also the full name of the patient. Please mark the fax “Booking for CPX”. You will then receive a confirmation by fax or email within 24 hours of the patient booking. In the event of a cancellation, please aim to give 48 hours notice as a minimum.

 

Additional information

Please wear comfortable clothes and shoes since some mild pedalling on an exercise bike like machine is required. Changing facilities and showering facilities are available within health screening for patents and a chaperone is available if requested to be present.
   

                    

BUPA press release - New trial reduces risk of surgery

 

 

General Disclaimer
This page is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through these pagess should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.