Non-pharmacological Interventions for Preoperative Anxiety in Children: A Systematic Review and Network Meta-Analysis

Aims: This study aimed to compare the efficacy of non-pharmacological interventions in children with preoperative anxiety.

Background: It is estimated that preoperative anxiety affects up to 60% of children which is associated with both immediate and long-term adverse outcomes. Several non-pharmacological interventions have been demonstrated to be effective, but further research is necessary to determine which is the most effective.

Design: This study was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist.

Methods: We searched randomised controlled trials in twelve databases from which inception to March 31, 2024. The primary outcome was the severity of preoperative anxiety change from the baseline to the endpoint which is usually before the anaesthesia induction. Within the frequentist framework, a random-effects network meta-analysis (NMA) was used to compare the primary outcomes. The surface under the cumulative ranking curve (SUCRA) was used to rank each intervention separately. Subgroup and sensitivity analyses were carried out for the primary outcomes.

Results: A total of 36 randomised controlled trials (RCTs) with 3182 paediatric patients were included. Based on the results, psychological + digital health intervention was significantly more effective than control groups and ranked highest. Combined parental presence during induction anaesthesia and video games (PPIA + VG) had significant benefits compared to almost all other interventions with the highest rank.

Conclusion: Psychological + digital health interventions, especially PPIA + VG, may be the most effective non-pharmacological interventions for reducing preoperative anxiety in children. It is necessary to conduct more RCTs to evaluate the efficacy of different non-pharmacological interventions.

Relevance to clinical practice: Non-pharmacological interventions can effectively improve preoperative anxiety in children.

Patient or public contribution: No patient or public contribution applies to this work.

Trial registration: PROSPERO CRD42024509512 (https://www.crd.york.ac.uk/PROSPERO/).