Background

• 80/M for right nephrectomy, incidental finding on USS for nocturia
• Severe COPD. Smoked since age 11, 100/day, quit 1 month ago.
• Spirometry in clinic: FEV1 36% pred, SpO2 96% on RA
• Staging CT showed bullous emphysema
• Functionally manages well, describes reasonable exercise tolerance, denies dyspnoea with daily activities. Walks around the block daily.
• Mini-cog 2/5

Issues

• Elevated perioperative risk:
  • Severe respiratory disease placing him at high risk for post-operative pulmonary complications
  • Risk for post-operative delirium/POCD
• Opportunity for optimisation?

Discussion

• CPET would be useful as an objective way of quantifying exercise tolerance over patient’s subjective report. This would aid quantification of perioperative risk. 
• Prehabilitation would also be useful and CPET would assist planning a program for this. 

Plan

• CPET testing followed by prehabilitation program