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

Abstract

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. Significant increase in lung resections for necrotizing pneumonia in children in the past decade: outcomes and follow-up Aim of the study The majority of community-acquired pneumonias in children are managed conservatively without the need for surgical intervention. Surgical resection for necrotizing pneumonia is the last but rescue solution for the most severely affected child. The incidence of necrotising pneumonia has increased in recent years [1-4]. This single-centre study reviews the occurrence of necrotizing pneumonia, the types of surgical management, and outcomes of lung resection, and it prospectively evaluates the postoperative follow-up spirometry in children. Methods We performed a prospective-retrospective, single-centre study of patients with necrotizing pneumonia who underwent parenchymal resection for necrotizing pneumonia between