Modified enhanced pleural fixation: combined intra- and postoperative hypertonic glucose in elderly and high-risk pulmonary bullae patients - a retrospective cohort study.

BACKGROUND

Although mechanical pleurectomy effectively prevents recurrent pneumothorax in elderly patients with diffuse emphysematous bullae, it entails substantial surgical trauma and postoperative pain. This study evaluates an enhanced pleurodesis technique-combining intraoperative hypertonic glucose spraying with three-day postoperative intrapleural perfusion-as a minimally invasive alternative.

METHODS

A retrospective analysis included 155 patients who underwent thoracoscopic bullectomy: 72 in the glucose protocol group and 83 in the parietal pleurectomy control group. Following 1:1 propensity score matching, 72 well-balanced matched pairs were obtained.

RESULTS

The glucose protocol group exhibited significantly improved perioperative outcomes compared with the parietal pleurectomy control group, including shorter operative duration (65.33 ± 2.43 vs. 84.92 ± 2.35 min), reduced intraoperative blood loss (50.00 ± 3.82 vs. 71.89 ± 4.62 mL), lower postoperative chest tube drainage volume (551.39 ± 27.76 vs. 785.42 ± 57.83 mL), shorter chest tube dwell time (4.42 ± 0.17 vs. 5.32 ± 0.21 days), lower pain scores on postoperative day 3 (0.93 ± 0.07 vs. 1.28 ± 0.06), and shorter length of hospital stay (5.04 ± 0.16 vs. 6.31 ± 0.24 days) (all P < 0.05). No significant differences were observed in postoperative complication rates (18.1% vs. 15.3%) or one-year pneumothorax recurrence rates (4.2% vs. 2.8%) between the two groups (both P > 0.05).

CONCLUSION

In this retrospective, propensity-score matched cohort study involving elderly high-risk patients with recurrent diffuse pulmonary bullae, an enhanced pleurodesis protocol-comprising intraoperative hypertonic glucose spray followed by three-day postoperative intrapleural perfusion-was associated with significantly improved perioperative outcomes compared with parietal pleurectomy. No statistically significant difference was detected in 1-year recurrence; however, this finding should not be interpreted as evidence of equivalence or non-inferiority because the recurrence analysis was underpowered and no non-inferiority margin was prespecified. These results indicate that the glucose-based protocol may serve as a viable, less invasive alternative to mechanical pleurectomy in this vulnerable population; however, validation through prospective, randomized controlled trials remains essential to establish causality and generalizability.