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Cardiopulmonary exercise testing (CPET) is being used topredict post-operative outcome. It is unclear if this tool is as accurate as the validated subjective ACPGBI CRC model and P-POSSUM scores. This study compares the three scoring systems with respect to 30-day outcome after elective colorectal surgery.Between September and November 2009, 60 patients underwent elective large bowel resections. Four patients were excluded following high CPETpredicted mortality. Patients wereprospectively scored using allpredictive tools. At 30 days, actual mortality was compared to thatpredicted by each tool.M:F, 39:21, median age 69 years. Pre-operative CPET scored 26 patients in a high risk group (predicted mortality; 4.6-9.4%), 18 intermediate risk (1.7-4.6%) and 12 low risk (0-1.7%). P-POSSUMpredictions were 27 (9.7%), 22 (2.8%) and 7 (0.7%), whilst ACPGBI CRCpredictions were 25 (9.2%), 17 (3.4%) and 8 (1.4%) in each respective category. Actual mortality observed at 30 days was 1 (3.8%) in the high risk group. CPET scores were highly statistically significant when correlated to P-POSSUM and ACPGBI CRC scores (P < 0.001 and P = 0.007).Pre-operative CPET accuratelypredicts post-operative outcome and closely correlates to P-POSSUM and ACPGBIpredictive scores.