Refining Postoperative Intensive Care Triage After Anatomical Lung Resection: A Retrospective Cohort Study of Perioperative Reassessment

Background/Objectives: Postoperative intensive care unit (ICU) disposition after anatomical lung resection is usually planned preoperatively, but the final care pathway may be substantially influenced by intraoperative events. We evaluated actual postoperative ICU admission among patients with a documented preoperative ICU monitoring recommendation and compared preoperative-only and perioperative triage approaches. Methods: In this retrospective single-centre cohort study, 1060 adults undergoing elective anatomical lung resection for non-small cell lung cancer (NSCLC) between January 2019 and December 2025 were screened; 159 patients with a documented preoperative ICU monitoring recommendation constituted the analytical cohort. A clinically pre-specified primary perioperative model incorporating operative duration, intraoperative complication, chronic obstructive pulmonary disease (COPD), and pre-existing arrhythmia was compared with a preoperative-only model and with an exploratory perioperative ICU triage score. Results: Actual postoperative ICU admission occurred in 45 patients (28.3%). Operative duration (adjusted odds ratio [OR] 1.012 per minute; 95% confidence interval [CI], 1.005–1.018; p < 0.001) and intraoperative complication (adjusted OR 15.002; 95% CI, 3.738–60.210; p < 0.001) were significantly associated with actual postoperative ICU admission. The primary perioperative model achieved an AUC of 0.802 (95% CI, 0.717–0.876), compared with 0.759 for the exploratory perioperative triage score and 0.665 for the preoperative-only model. Conclusions: Fewer than one-third of patients with a documented preoperative ICU monitoring recommendation underwent actual postoperative ICU admission. In this selected cohort, perioperative reassessment incorporating intraoperative information showed higher apparent discriminative performance than the preoperative-only approach while the exploratory score showed intermediate, hypothesis-generating performance. Because the outcome reflected observed institutional ICU disposition rather than independently adjudicated ICU-level care requirement, prospective multicentre validation using predefined ICU admission criteria is required before clinical implementation.