Perioperative corticosteroids and venous thromboembolism risk: a systematic review with exploratory pooled meta-analysis

Background: Perioperative corticosteroids suppress pro-inflammatory pathways that drive postoperative coagulation, suggesting a potential anti-thrombotic effect. No prior systematic review has examined this relationship. Methods: We systematically reviewed studies reporting DVT or PE in patients receiving perioperative corticosteroids versus controls (MEDLINE, Embase, CENTRAL; inception–January 2026), performing an exploratory pooled analysis using a random-effects model with GRADE certainty assessment. Risk of bias was assessed using RoB 2 (RCT) and the Newcastle-Ottawa Scale (observational studies). Results: Four studies (78,282 patients) were included. Pooled DVT analysis showed a statistically significant reduction favoring corticosteroids (RR 0.85, 95% CI 0.75–0.96; p = 0.008; I2 = 0%); however, one observational study contributed 96.7% of patient-level weight, rendering the estimate functionally a single-study restatement. Excluding it reversed the effect direction. The only RCT trended toward DVT harm (RR 1.20). The PE estimate was non-significant (RR 0.55, 95% CI 0.23–1.31; p = 0.18; I2 = 47%). GRADE certainty was very low for all outcomes. Conclusions: The apparent DVT benefit reflects healthy-user confounding in a dominant observational study and is unsupported by randomized evidence. A dedicated, adequately powered RCT with pre-specified VTE endpoints, is urgently needed. Protocol registration: www.crd.york.ac.uk/prospero; identifier is CRD420261325249.