Purpose <p>Vertebral body tethering (VBT) is an emerging treatment option for idiopathic scoliosis, but routinely requires intraoperative placement of a chest tube (CT). Topical thrombin and injectable collagen have routinely been used as a hemostatic agent, but data are lacking on its use in VBT. Thus, we aim to investigate the impact of the topical hemostatic use on CT output and duration, and the subsequent rate of clinically-significant hemothorax and effusion after VBT.</p> Methods <p>Retrospective review was conducted on patients who underwent VBT at a single institution between 2015 and 2024. Patients were grouped to whether they were treated with FDA-approved, topically applied recombinant thrombin and injectable collagen intraoperatively. We hypothesized that there would be fewer thoracic and chest tube complications in the topical hemostatic group based on their 90-day perioperative outcomes.</p> Results <p>Out of 190 patients who&#xa0;underwent VBT, 92 received thrombin and injectable collagen intraoperatively while 98 did not. Mean age at surgery was 13 (range 9–17) years. Adjusting for chest tube size and number of instrumented levels, regression analysis showed significant decrease in CT output, CT duration, and the odds of developing clinically significant pleural effusion with the use of intraoperative topical hemostatic agents. Two cases of in-hospital hemothorax were found in the non-topical hemostatic group and none in the group with topical hemostatic.</p> Conclusions <p>Applying topical thrombin and injectable collagen during surgery decreases CT output and duration following VBT, as well as the odds of developing clinically significant pleural effusion. This may serve as an alternative to the use of 24-h intravenous hemostatic agent such as tranexamic acid. Level of Evidence: Level III–Retrospective Cohort Study.</p> Level of evidence <p>Level III–Retrospective Cohort Study.</p>