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 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: http://www.crd.york.ac.uk/prospero; identifier is CRD420261325249.