Preoperative Clearance for Sacroiliac Joint Surgery

Preoperative Risk Stratification

The American College of Cardiology recommends that men 45 years or older starting any surgical program should undergo cardiovascular risk assessment using screening tools 3
Frailty is the strongest predictor of mortality at 12 months post-surgery, along with increased ASA status, in patients over 65 years undergoing sacroiliac joint surgery 1
The American Heart Association suggests that evaluating for valvular heart disease, particularly aortic stenosis, is crucial in elderly patients 4
Frailty demonstrates a dose-dependent effect on failure-to-rescue (FTR), postoperative complications, reoperation, and all-cause mortality in older surgical patients 1

The Annals of the Rheumatic Diseases recommend that systematic multidisciplinary preoperative assessment must include nutritional status evaluation, as malnutrition is a critical modifiable risk factor 5
Electrolyte and volume status disturbances must be corrected preoperatively, according to the Annals of the Rheumatic Diseases 5
Anemia screening, including full blood count and correction if needed, is essential preoperatively 5
Renal function assessment is necessary, as it impacts medication dosing and perioperative management 5
Cognitive baseline function, including dementia and delirium risk assessment, should be evaluated preoperatively 5
Pulmonary disease evaluation, including chest X-ray, is required preoperatively 5
ECG and cardiac assessment are necessary preoperatively 5

Fluoroscopically guided diagnostic SI joint injection with ≥75-80% pain relief is required to confirm the SI joint as the source of pain before considering surgery, as recommended by the journal PM&R 7

The World Journal of Emergency Surgery suggests that involvement of a physician specialized in care of older adults must occur as soon as possible preoperatively, and comprehensive geriatric assessment (CGA) significantly reduces mortality, length of stay, and discharge to higher levels of care 1, 2
Local protocols with physiological track and trigger systems must be implemented to alert to deterioration and prevent failure-to-rescue, according to the World Journal of Emergency Surgery 1, 2
Rapid response teams, including an intensivist experienced in postoperative surgical management, should be available 1
Early intervention protocols are critical, as prevention of cascade from initial complication to FTR is a specific area for improvement 1

Failing to screen for frailty in patients over 65 is a critical error, as frailty is the strongest predictor of poor outcomes and must be assessed, according to the World Journal of Emergency Surgery 1, 2
Inadequate preoperative medical optimization, including correction of malnutrition, anemia, electrolyte disturbances, and cardiac/pulmonary issues, is a common pitfall, as recommended by the Annals of the Rheumatic Diseases 5
Not involving geriatric co-management preoperatively misses critical optimization opportunities, according to the World Journal of Emergency Surgery 1, 2