Beyond Age: Radiological and Inflammatory Factors Associated with Hospital Stay After VATS in Pediatric Complicated Pneumonia—A 10-Year Single-Center Experience

Background/Objectives: We aimed to describe the clinical, laboratory, and radiological characteristics of children with complicated pneumonia/empyema who underwent video-assisted thoracoscopic surgery (VATS) and to identify factors associated with length of hospital stay. Methods: We retrospectively reviewed 68 children who presented to the pediatric emergency department of a tertiary university hospital and underwent VATS between April 2015 and April 2025. Factors associated with length of stay were assessed using univariable and multivariable negative binomial regression. Results: Median age was 60 months (interquartile range 36–138), and 66% were male. On univariable analysis, C-reactive protein (CRP) was associated with length of stay (incidence rate ratio [IRR] = 1.03 per 100 mg/L; p = 0.034), whereas age was not (p = 0.542). In the multivariable model, CRP remained borderline associated (IRR = 1.03; 95% confidence interval [CI] 1.00–1.06; p = 0.049), whereas performance of computed tomography was not (p = 0.142). An atypical (gastrointestinal or pain-predominant) presentation occurred in 25%. Streptococcus pneumoniae was the most frequently detected bacterial pathogen, mainly by nasopharyngeal polymerase chain reaction. Conclusions: In this single-center, retrospective cohort, higher CRP at presentation, but not age, was modestly associated with a longer hospital stay; this small association needs confirmation in larger prospective studies, and most children (82%) were managed with VATS alone.