Comparative postoperative outcomes of autologous fibrin sealant pleurodesis versus talc pleurodesis in patients with spontaneous pneumothorax: a prospective cohort study

Background: Spontaneous pneumothorax often requires pleurodesis to prevent recurrence. Talc poudrage is effective but induces pleural inflammation. Autologous fibrin sealant offers a potentially less inflammatory alternative, but comparative data are limited. The objective of this study was to compare postoperative outcomes, including pain, chest drain duration, complications, and recurrence, between thoracoscopic talc pleurodesis and autologous fibrin sealant pleurodesis in patients with spontaneous pneumothorax. Methods: This prospective single-center cohort study included 64 patients undergoing thoracoscopic management of spontaneous pneumothorax (30 undergoing talc pleurodesis and 34 receiving autologous fibrin pleurodesis) between January 2020 and March 2023. In the fibrin group, an autologous fibrin sealant was generated intraoperatively using the Vivostat® system, which processes autologous blood to produce a fibrin-rich, cell-free sealant, distinct from conventional autologous blood pleurodesis. Outcomes were analyzed using covariate-balancing propensity score weighting and weighted regression models. Results: The talc pleurodesis group had a significantly shorter operative time (40 vs. 45 minutes, P=0.047). However, after adjustment, the difference in operative time was not significant (adjusted P=0.82). Fibrin pleurodesis offered an advantage in pain control, with significant differences observed on days 2, 3, and 4 (P