Effects of non-drug interventions to alleviate anxiety in children undergoing surgery: a systematic review and meta-analysis

Background: Seventy-five percent of children undergoing surgery report preoperative anxiety symptoms. Non-drug interventions are simple and cost-efficient, offering multiple types of approaches. However, no previous meta-analysis has evaluated the efficacy of these approaches in reducing anxiety in children during the preoperative period. The aim of this study was to evaluate the efficacy of various non-drugs programs in decreasing anxiety symptoms in children during the preoperative period. Methods: We conducted a systematic review and meta-analysis to determine if preoperative interventions can effectively reduce anxiety in children. We searched PubMed, Web of Science, and Scopus for randomized control trial from inception to July 2024. Quantitative synthesis was performed using The Review Manager 5 (RevMan 5) software. Results: Thirty studies were selected, with an overall risk of bias rating of ‘high risk’, and 66.6% of the studies were of good quality according to the Jadad scores. The preoperative interventions included in the meta-analysis were divided into passive distractions, active distractions, and mixed interventions, involving 763, 597, and 1,184 children, respectively. Preoperative interventions showed significant differences compared to standard care or no intervention, resulting in a reduction in anxiety levels (P<0.001), although there was high heterogeneity (86%). Conclusions: Non-drug programs, especially active distraction interventions, reduce anxiety symptoms in children during the preoperative period. However, future studies are needed to address the high heterogeneity observed in our findings and to assess their long-term effects after the postoperative period.