Background: In the Netherlands Cancer Institute (NCI), patients are admitted to the Intensive Care Unit (ICU) after total laryngectomy (TL). Aims/Objectives: To assess direct complications and the need for ICU admission after TL. Material and methods: Patients who underwent a TL in the NCI were reviewed on the occurrence of an event requiring ICU treatment within the first 24 hours postoperatively. The predictive value of predetermined risk factors was assessed with multivariable logistic analysis. The optimal threshold of the risk score assigned by the resulting model was determined. Results: An event occurred in 25 of the 113 patients (22%) of which 72% included norepinephrine dependence. Risk analysis showed that patients with either CRT prior to TL or a procedure including pharynx reconstruction, or both, should be indicated for ICU stay. Applying the rule on this cohort, 57 patients (50%) would have been sent to the ward postoperatively of which seven (12%) developed an event requiring ICU treatment. Conclusions: A substantial proportion of the patients developed an event within the first 24 hours after TL. Our risk stratification of patients based on the mentioned risk factors is insufficiently accurate. Significance: The study provides an overview of direct postoperative complications after TL.