The Role of Preoperative Virtual Reality for Anxiety Reduction in Pediatric Surgical Patients: A Systematic Review and Meta-Analysis.

Preoperative anxiety is a common and significant issue in pediatric surgical patients, often leading to adverse postoperative outcomes such as increased pain, delayed recovery, and emergence delirium. Traditional methods to address this anxiety, including pharmacological interventions like midazolam, can cause undesirable side effects while non-pharmacological approaches, such as parental presence and cognitive-behavioral therapies, require substantial resources. Virtual reality (VR) has emerged as a promising, non-invasive intervention that immerses children in engaging and distracting virtual environments to reduce anxiety. This systematic review and meta-analysis evaluated the effectiveness of VR in alleviating preoperative anxiety in pediatric patients compared to other interventions. A systematic search of randomized controlled trials (RCTs) was conducted using databases such as PubMed, Scopus, Cochrane Library, and Web of Science. Studies involving pediatric patients aged 4-12 years undergoing surgery and using VR were included. The primary outcome was a reduction in preoperative anxiety levels measured by validated scales such as the Modified Yale Preoperative Anxiety Scale (m-YPAS). Secondary outcomes included emergence delirium, postoperative behavioral disturbances, and parental anxiety. Five RCTs involving 356 pediatric patients met the inclusion criteria, with three studies contributing to the meta-analysis. Results demonstrated that VR interventions significantly reduced preoperative anxiety in children compared to control groups, with a pooled standardized mean difference of -0.73 (95% CI: -1.15 to -0.31, p < 0.001). VR was particularly effective when used shortly before surgery and in children aged 5-10 years. No significant differences were observed in the incidence of emergence delirium, postoperative behavioral disturbances, or parental anxiety between VR and control groups. These findings indicate that VR is an effective, safe, and non-invasive tool for managing preoperative anxiety in pediatric surgical patients. Further research is needed to assess the long-term effects of VR and standardize its implementation across different surgical settings. Integrating VR into routine preoperative care could significantly improve the surgical experience for children and their families.