Here we have a very special edition of Journal Club, in two distinct parts; the The Measurement of Exercise Tolerance before Surgery (METS) trial is discussed here both before and after the results were released into the public domain.

The Measurement of Exercise Tolerance before Surgery (METS) trial has both raised, and answered, complicated questions. How will it change practice? Will it alter the use of the Duke Activity Status Index (DASI) for example? Cardiopulmonary Exercise Testing (CPET) clearly predicts major complications and is more predictive than the comparators. Why is this not clear in the abstract? Why is there an obsession with major cardiac events when they are rare?

The links mentioned in the piece are here:

https://bmjopen.bmj.com/content/6/3/e010359

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31131-0/fulltext

Presented by Monty Mythen and Desiree Chappell with their guest Professor Mike Grocott of Southampton University and a lead investigator in the METS trial and an author of the paper.