Objective To explore the application effects of stratified nursing intervention under the pneumothorax risk assessment strategy in the perioperative period of patients undergoing microwave ablation (MWA) of lung tumors.

Methods A total of 96 patients with lung tumors who underwent MWA in the thoracic surgery department of a tertiary grade A hospital in Jiangsu Province from January 2024 to February 2025 were selected. After completing the risk assessment of pneumothorax before the operation, the patients were divided into the observation group and control group by the random number table method, with 48 cases in each group. The observation group received stratified nursing based on the risk level of pneumothorax, while the control group only recorded the risk level, and was given routine nursing. The intervention in two groups continued until discharge. The incidence of pneumothorax, duration of pneumothorax, length of hospital stay and satisfaction with nursing care were compared between two groups.

Results There was no statistically significant difference in the distribution of preoperative risk levels between two groups (P = 0.97). Compared with the control group, the incidence of pneumothorax in the observation group was significantly lower (P = 0.04), the duration of pneumothorax was shortened (P = 0.046), and the length of hospital stay was reduced (P ＜ 0.01). The satisfaction rate of nursing in the observation group was higher than that in control group, but the difference did not reach statistically significant (P = 0.15).

Conclusions Stratified nursing under the pneumothorax risk assessment strategy can effectively reduce the incidence of pneumothorax after MWA for lung tumors, shorten the duration of pneumothorax and hospital stay, improve nursing satisfaction, and help improve the prognosis of patients and provide a feasible nursing strategy.