This study found that a higher neutrophil percentage to albumin ratio (NPAR) on hospital admission significantly predicts in-hospital mortality in patients undergoing surgery for acute type A aortic dissection (AAAD). Among 813 patients, higher NPAR levels correlated with increased risk of death, acute kidney injury, and longer ICU stays. NPAR outperformed neutrophils or albumin alone in prognostic value, suggesting it as a valuable, accessible clinical biomarker.