OBJECTIVE: To use meta-analytic techniques to examine the effect of dexamethasone on the risk of postoperative bleeding following tonsillectomy. DATA SOURCES: PubMed and Embase databases accessed on April 23, 2009, and April 28, 2009. REVIEW METHODS: Using principles of meta-analysis, inclusion and exclusion criteria were developed to identify all randomized controlled trials of patients undergoing tonsillectomy in which perioperative intravenous dexamethasone was administered in at least 1 treatment arm and bleeding complications were reported. Electronic databases were searched to identify candidate articles. Two authors independently abstracted data from each article. Discrepancies were resolved by consensus. A fixed-effects model was used to pool relative risks among studies using the Mantel-Haenszel method. Studies were assessed for publication bias using a funnel plot of studies' effect size vs standard error of the effect size as well as Begg test and Egger test. A P value <.05 was considered significant. RESULTS: The primary search identified 85 potential studies. Fourteen met inclusion criteria and were selected for meta-analysis. No significant heterogeneity was found among studies (I(2)< 0.1%; 95% confidence interval [CI], 0%-55%; P = .68). The pooled relative risk (RR) of postoperative bleeding did not differ significantly between patients receiving dexamethasone and controls (RR, 1.02; 95% CI, 0.65-1.61; P = .92). When studies were stratified by age, primary vs secondary hemorrhage, and follow-up duration, no further significant differences in bleeding rate were identified. No evidence of publication bias was found using Begg (P = .70) or Egger (P = .73) tests. CONCLUSION: The results of this meta-analysis indicate that perioperative dexamethasone does not confer an increased risk of postoperative bleeding in patients undergoing tonsillectomy.