Faculty of Anaesthesiology, Reanimation and Perioperative Medicine | The AHMAD Pathway for Surgical Readiness: A Multidisciplinary Metabolic-Respiratory Prehabilitation and Perioperative Decision Instrument

Abstract

The AHMAD Pathway for Surgical Readiness is a clinician-facing implementation and research instrument for multidisciplinary metabolic-respiratory prehabilitation before elective surgery. The pathway organizes care into five linked components: Assess; Hypoventilation, Hypoxemia, and Obstructive Sleep Apnea; Metabolic Management; Activate Prehabilitation; and Determine Readiness. It provides structured records for baseline assessment, respiratory and metabolic management, functional and nutritional preparation, reassessment, shared decision-making, day-of-procedure safety, and prospective implementation research. This Version 1 instrument was peer reviewed as the operational framework within IVURH Journal Article 11, “From Obesity Treatment to Surgical Readiness: Tirzepatide, Obstructive Sleep Apnea, and the Proposed AHMAD Pathway,” DOI: 10.5281/zenodo.22165041. The instrument is proposed and has not yet been clinically validated. It is not a clinical guideline, numerical risk score, prescribing instrument, universal medication-withholding rule, or automatic reason to delay surgery. Urgent and time-sensitive procedures should not be delayed to complete the pathway. Local policy, current evidence, individual clinical judgment, informed consent, and appropriate clinical governance remain controlling.