Safety and long-term outcomes of surgical intervention in pediatrics with necrotizing pneumonia: a retrospective cohort study.

UNLABELLED: This study aimed to analyze the evolving etiology, clinical features, surgical outcomes, and long-term prognosis of pediatric necrotizing pneumonia (NP). Data were collected from 398 children diagnosed with NP between January 2017 and June 2025, among whom 42 (10.55%) required surgical intervention due to failed medical therapy. Pathogens were identified in 95.2% of cases, with mycoplasma pneumoniae being the most common (52.50%). Preoperative complications were present in 83.33% of patients. The mean operative time was 140.71 ± 49.84 min, intraoperative blood loss was 119.79 ± 49.97 mL, chest tube duration was 7.83 ± 3.05 days, and postoperative hospital stay was 14.74 ± 3.53 days. Compared with the non-resection group, the parenchymal resection group had significantly longer operative time (P < 0.001) and greater blood loss (P < 0.05), but no significant differences were observed in drainage duration or length of hospital stay (P > 0.05). Five postoperative pulmonary adverse events occurred, all of which resolved completely with conservative management. During a median follow-up of 64.4 months (range 5-101 months), no recurrence or mortality was observed.

CONCLUSION

Timely surgical intervention, including lung resection when necessary, is safe and associated with excellent long-term recovery in pediatric NP, providing crucial evidence to guide surgical decision-making.

WHAT IS KNOWN: • Necrotizing pneumonia (NP) is a severe, increasingly recognized complication of community-acquired pneumonia in preschool children, characterized by pulmonary parenchymal destruction and cavity formation. • While surgical intervention is required for pediatric NP after failed medical therapy or complications, a clear understanding of its safety, perioperative outcomes, and long-term prognosis is lacking.

WHAT IS NEW: • The predominance of mycoplasma pneumoniae updates the disease's etiology and calls for routine testing of atypical pathogens. • Timely and individualized surgical intervention plays a pivotal role in the management of pediatric NP when medical therapy fails or complications develop.