Key result
Chronic preoperative corticosteroid use is linked to a ~51% higher risk of postoperative VTE.
Why the study?
Chronic corticosteroid use is prevalent among surgical patients, but its association with postoperative venous thromboembolism had not been systematically quantified.
Does chronic preoperative corticosteroid use increase the risk of postoperative venous thromboembolism in adult surgical patients?
Meta-Analysis (n=2,678,513)
Does chronic preoperative corticosteroid use increase the risk of postoperative venous thromboembolism in adult surgical patients?
Relative Risk: 1.51 (95% CI 1.31–1.73)
Chronic preoperative corticosteroid use is associated with a 51% increased risk of postoperative VTE, suggesting it should be considered in perioperative risk assessments.
May inform perioperative VTE risk stratification; leaves open causal confirmation in prospective trials.
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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Srivali et al. (2026) conducted a meta-analysis in Surgical patients (n=2,678,513). Chronic preoperative corticosteroid use vs. No chronic corticosteroid use was evaluated on Composite VTE risk (RR 1.51, 95% CI 1.31-1.73). Chronic preoperative corticosteroid use was associated with a significantly increased risk of postoperative venous thromboembolism (RR 1.51; 95% CI 1.31-1.73).
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