Purpose: To quantify postoperative intensive care unit (ICU) utilisation for general surgery in a regional Australian centre and characterise critical-care burden and predictors of ICU demand. Methodology: Retrospective cohort of General Surgery admissions at a regional public hospital in Australia undergoing an operative/endoscopic theatre procedure (Jan 2020–Sep 2025). Theatre, electronic medical record, ICU records were used to collect data, including ICD-10-AM and ACHI/MBS codes. Postoperative ICU admission was defined as ICU stay ≥1 hour after the index procedure. Multivariable logistic regression evaluated predictors using pre-specified demographic, comorbidity, urgency and rurality covariates. Results: Among 21,978 admissions, 929 (4.2%) required ICU care. ICU patients were older (median 71 vs 57 years) and more often male (62.3% vs 47.5%). Median ICU length of stay was 50 h (IQR 25–97.5); 392/929 (42.2%) required invasive ventilation (median 41 h, IQR 16–83). In-hospital mortality was 8.5% in ICU patients versus 0.27% in non-ICU. ICU admissions were predominantly from regional/rural areas (MMM2 53.5%; MMM3–5 43.4%). Independent predictors of ICU admission included age (OR 1.03/year), emergency surgery (OR 1.29), increasing MMM category (OR 1.15/category) and chronic lung disease (OR 6.62); female sex was protective (OR 0.62). In ICU patients, emergency surgery was strongly associated with in-hospital mortality (OR 7.99). Conclusions: ICU utilisation for general surgery was infrequent (4.2%) but carried substantial ventilation requirements and mortality in this regional cohort. Demand was concentrated among older, emergency and comorbid patients and those from more rural catchments. This supports data-driven ICU capacity, staffing and perioperative escalation planning in regional health services.