Postoperative management after major lung surgery is critical. This study evaluates risk factors for predicting mandatory intensive care unit (ICU) admission immediately after major lung resection. We retrospectively reviewed patients for whom the surgeon requested an ICU bed before major lung resection surgery. Patients were classified into three groups. Univariable and multivariable logistic regression analyses were performed, and a clinical nomogram was constructed. Among 340 patients, 269, 50, and 21 were classified into the no need for ICU, mandatory ICU admission, and late-onset complication groups, respectively. Predictive postoperative diffusion capacity of the lung for carbon monoxide (47.2 (interquartile range (IQR) 43.3−65.7)% versus vs. 67.8 (57.1−79.7)%; p = 0.003, odds ratio (OR) 0.969, 95% confidence interval (CI) 0.95−0.99), intraoperative blood loss (400.00 (250.00−775.00) mL vs. 100.00 (50.00−250.00) mL; p = 0.040, OR 1.001, 95% CI 1.000−1.002), and open thoracotomy (p = 0.030, OR 2.794, 95% CI 1.11−7.07) were significant predictors for mandatory ICU admission. The risk estimation nomogram demonstrated good accuracy in estimating the risk of mandatory ICU admission (concordance index 83.53%). In order to predict the need for intensive care after major lung resection, preoperative and intraoperative factors need to be considered.
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