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Colorectal surgery is associated with considerable morbidity. Patient-related factors are important in determining the postoperative outcome. Thepredictive power of individual patient factors and patient outcome 6 months after the introduction of a risk stratifying CPET algorithm was assessed.Sixty patients undergoing elective large bowel resection were recruitedprospectively. They were stratifiedpre-operatively for risk using CPET. Patients were followed for up to 180 days, when morbidity, mortality, length of HDU/ITU stay and patient variables were analysed.Four patients were excluded due to high CPETpredicted mortality. CPET scored 26 patients to be at high-risk (predicted mortality; 4.6-9.4%), 18 at intermediate risk (1.7-4.6%) and 12 at low-risk (0-1.7%). Actual morbidity at 180 days was 57.2% in the high risk group, 16.6% in the intermediate group and 8.3% in the low risk group. Actual 180 day mortality was 7.7% (n = 2). The 30 day mortality was 3.8% (n = 1). The HDU/ITU stay was 62%, 22% and 8% respectively (median 2 days). Patients with a low anaerobic threshold (P ≤ 0.001), low VO2 peak (P ≤0.001) and low VO2 peak/BSA (P = 0.003), showed increased 180-day morbidity and longer highdependency stay. Conclusion: A CPET algorithm can reliably be used for risk stratification and accurateprediction of post-operative outcome.