Effectiveness of digital storytelling and immersive technology interventions in reducing preoperative anxiety among children: a systematic review and meta-analysis

Background Preoperative anxiety in children is a common challenge that can negatively impact surgical outcomes, cooperation, and recovery. Recently, digital storytelling and immersive technologies such as virtual reality (VR) and augmented reality (AR) have emerged as promising tools to improve the preoperative experience. This systematic review and meta-analysis aimed to evaluate the effectiveness of these digital interventions in reducing preoperative anxiety among pediatric patients undergoing elective surgery. Methods A search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library for studies published from January 2015 to June 2025. Eligible studies included randomized controlled trials and quasi-experimental designs assessing digital or immersive interventions in children aged 3 to 12 years. Validated anxiety measures such as the Modified Yale Preoperative Anxiety Scale (mYPAS), State-Trait Anxiety Inventory (STAI), or Visual Analog Scale (VAS) were required. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 1), and a random-effects meta-analysis was performed in R. Results Fifteen studies met inclusion criteria. Most interventions showed significant reductions in preoperative anxiety compared to standard care. Meta-analysis of five studies demonstrated a large, pooled effect size favoring digital interventions (SMD = − 0.99; 95% CI: − 1.44 to − 0.54), with moderate to high heterogeneity. Risk of bias was high in most studies, particularly regarding blinding. Conclusion Digital storytelling and immersive technologies are effective in reducing preoperative anxiety in children undergoing elective surgery and may serve as useful, child-centered alternatives to traditional preparation methods.