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Chronic Preoperative Corticosteroid Use and Postoperative Venous Thromboembolism Risk: A Systematic Review and
Narat Srivali1, Federica De Giacomi2
1Duke University School of Medicine, Medicine, North Carolina, United States, Durham.
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.
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