Significant increase in lung resections for necrotizing pneumonia in children in the past decade: outcomes and follow-up

Aim of the study: To review the occurrence, follow-up, and outcome of necrotizing pneumonia requiring surgical management. Methods: A prospective–retrospective, single-centre study of patients with necrotizing pneumonia managed between 1 January 2010 and 31 December 2019. Main results: The study cohort consisted of 1,295 patients admitted to the paediatric department for pneumonia, 36 of whom underwent parenchymal lung resection. A five-year rise in the occurrence of necrotizing pneumonia requiring resection was 77%, with a significant increase in the last three years (P<0.05). The median age at the time of surgery was 32.5 (interquartile range: 32.25) months. Streptococcus pneumoniae was the most prevalent pathogen (83%), although 53.3% of these patients were vaccinated against the agent. In 67% of patients, pre-resection procedures were performed: drainage of pneumothorax (17%), drainage of empyema (46%), drainage of empyema with use of alteplase (25%), and thoracoscopic decortication (12%). Surgical procedures included lobectomy (72.2%), wedge resection (13.9%), bilobectomy (8.3%) and pneumonectomy (5.6%). The post-operative complication was bronchopleural fistula in three patients. There were two (5.5%) postoperative deaths due to multiple organ failure. The follow-up spirometry performed 39.3 months (median) after surgical intervention was normal in 68.3% of patients, restriction was detected in 10.0%, and peripheral obstruction in 18.3%. Conclusions: Despite high rates of vaccination against pneumococcus, the number of patients with necrotising pneumonia requiring resection has increased significantly in the last three years (P<0.05). Aggressive surgical treatment results in significant clinical improvement in most cases and favourable lung function outcome.