[Pneumonia complicated with empyema in children, to operate or not? Risk factors for surgery and review of the literature].

The precise indication for surgery for pleural empyema is still a controversy. With the aim of identifying the risk factors associated with surgery in pediatric patients with empyema post-pneumonia, a retrospective case control study was performed. From 1992 to 1996, 18 children underwent surgery (cases) and 12 did not (controls). The analyzed variables were those mentioned in the literature as risk factors. More than 25 days of evolution, more than three antibiotic schemes, fever, empyema organizing phase, two or more chest tubes lasting more than nine days, multiple loculations, trapped lung and paquipleura were associated with thoracostomy and decortication (p < 0.05). We conclude that a pediatric patient with a late referral to the hospital, empyema organizing phase, and multiple loculations with large purulent collections no longer susceptible to drainage and complications that impair lung expansion will probably require major surgery.