Chronic Preoperative Corticosteroid Use and Postoperative Venous Thromboembolism Risk: A Systematic Review and Meta-Analysis

Background: Chronic corticosteroid use is prevalent among surgical patients, yet its association with postoperative venous thromboembolism (VTE) has not been systematically quantified. We conducted a systematic review and meta-analysis to assess this risk. Methods: We searched MEDLINE, Embase, and Cochrane Central through January 2026 (PROSPERO: CRD420261298063). Eligible studies were observational studies or RCTs examining chronic preoperative corticosteroid use and postoperative VTE in adult surgical patients. We used random-effects meta-analysis calculated pooled risk ratios (RR) with 95% confidence intervals. Evidence certainty was assessed using the GRADE approach and methodological quality using the Newcastle–Ottawa Scale. Results: Nine retrospective cohort studies (2,678,513 patients; 97,201 corticosteroid users) were included. Chronic corticosteroid use was associated with increased composite VTE risk (RR 1.51, 95% CI 1.31–1.73; I²=71%). PE did not reach statistical significance (RR 1.31, 95% CI 0.95–1.80), while DVT risk was significantly increased (RR 1.48, 95% CI 1.19–1.84; I²=64%). GRADE yielded low-quality evidence for composite VTE and DVT and very low-quality evidence for PE. Conclusions: Chronic preoperative corticosteroid use is associated with a 51% increased postoperative VTE risk across 2.6 million surgical patients, suggesting potential value in considering chronic corticosteroid use within perioperative VTE risk assessment, pending higher-quality prospective data. Current evidence is insufficient to support specific protocol changes; prospective studies are needed to define dose-response relationships.