This prospective observational study aims to evaluate whether the preoperative neutrophil percentage-to-albumin ratio (NPAR) is associated with post-induction hemodynamic vulnerability in adult patients undergoing elective major oncologic surgery under general anesthesia.
NPAR will be calculated from routine preoperative laboratory results by dividing the neutrophil percentage by the serum albumin level. No additional laboratory tests, medications, invasive procedures, or changes in anesthesia management will be performed for the purposes of the study.
Demographic characteristics, preoperative laboratory values, anesthetic data, and hemodynamic measurements will be recorded prospectively. Hemodynamic status will be evaluated during the period between induction of general anesthesia and surgical incision, with a maximum observation period of 20 minutes. Vasopressor use and administered doses will also be recorded.
The study will assess the ability of preoperative NPAR to identify patients who may be more susceptible to early hemodynamic instability following induction of general anesthesia.
Age 18 years or older
Scheduled for elective major oncologic surgery
Undergoing surgery under general anesthesia
Availability of preoperative complete blood count and serum albumin -measurements
Age younger than 18 years
Emergency surgery
Preoperative hemodynamic instability
Preoperative vasopressor or inotropic support
The study population will consist of adult patients aged 18 years or older who are scheduled to undergo elective major oncologic surgery under general anesthesia. Eligible participants must have available preoperative complete blood count and serum albumin measurements and undergo standard intraoperative hemodynamic monitoring. Patients will be enrolled consecutively at the study center. Individuals undergoing emergency surgery or presenting with preoperative hemodynamic instability, vasopressor or inotropic support, sepsis or active infection, hematologic malignancy, advanced cardiac, renal, or hepatic failure, pregnancy, or missing laboratory data will be excluded.
Cohort
Prospective
Not listed
Occurrence of Post-Induction Hemodynamic Vulnerability
Post-induction hemodynamic vulnerability will be defined as the occurrence of at least one mean arterial pressure (MAP) measurement ≤65 mmHg after induction of general anesthesia and before surgical incision. MAP will be assessed using standard intraoperative hemodynamic monitoring.
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