Association between preoperative chronic corticosteroid use and adverse postoperative outcomes following gastrointestinal surgery: a systematic review and meta-analysis

Background Preoperative chronic corticosteroid use has been associated with an increased risk of postoperative complications. However, its association with postoperative outcomes following gastrointestinal surgery remains unclear. This systematic review and meta-analysis aimed to evaluate this association. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to September 1, 2026. Eligible observational cohort studies compared patients with and without preoperative chronic corticosteroid exposure; studies restricted to inflammatory bowel disease were excluded. Adjusted estimates were pooled using random-effects models with restricted maximum likelihood and Hartung-Knapp confidence intervals after outcome-specific exclusion of potentially overlapping cohorts. Risk of bias and certainty of evidence were assessed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. Results Fourteen retrospective cohort studies were included, seven of which contributed to quantitative synthesis. Bariatric surgery accounted for 65.2% of reported participants. The primary mortality analysis included five studies comprising 776,681 patients after overlap exclusions. Preoperative exposure was associated with higher odds of 30-day mortality (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI] 1.26–1.81), readmission (aOR 1.26, 95% CI 1.07–1.48), reoperation (aOR 1.32, 95% CI 1.10–1.59), sepsis (aOR 1.40, 95% CI 1.36–1.43), and organ-space surgical site infection (SSI; aOR 1.26, 95% CI 1.16–1.37). No statistically significant associations were found for superficial or deep SSI. Mortality and sepsis associations persisted in corticosteroid-specific analyses; readmission, reoperation, and organ-space SSI findings were less consistent across sensitivity analyses. Individual SSI analyses included only two studies and predominantly reflected colorectal surgery. Composite outcomes were summarized narratively. Evidence certainty was low or very low. Conclusions Preoperative chronic corticosteroid exposure, as defined in the included studies, was associated with higher odds of adverse postoperative outcomes. The associations with mortality and sepsis were more consistent across sensitivity analyses. Given the mixed exposure definitions and residual confounding, the observed associations cannot be attributed to corticosteroids alone or generalized to all gastrointestinal procedures. These findings may support careful perioperative risk stratification and postoperative monitoring in these patients. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359719 , identifier CRD420261359719.