Clinician Article

Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews.

  • Aguero-Millan B
  • Abajas-Bustillo R
  • Ortego-Mate C
J Clin Nurs. 2023 Sep;32(17-18):6229-6242. doi: 10.1111/jocn.16755. Epub 2023 May 6. (Review)
PMID: 37149743
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  • FM/GP/Mental Health
    Relevance - 5/7
    Newsworthiness - 5/7
  • Surgery - General
    Relevance - 4/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 4/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 4/7
    Newsworthiness - 5/7
  • Psychiatry
    Relevance - 4/7
    Newsworthiness - 4/7


AIMS AND OBJECTIVES: Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety?

BACKGROUND: Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery.

INTRODUCTION: According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety.

DESIGN: Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety.

METHODS: A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO.

RESULTS: A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results.

CONCLUSION: Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs.

RELEVANCE TO CLINICAL PRACTICE: This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results.

NO PATIENT OR PUBLIC CONTRIBUTION: Not applied to our study, as it is a systematic review of systematic reviews.

Clinical Comments

Family Medicine (FM)/General Practice (GP)

Wouldn't this be more relevant to anesthesiology rather than primary care? Even surgical specialties?


I think the paper tried to address an important topic. It just seems that the variables are too great for meaningful conclusions. First, I couldn't tell whether these studies were all inpatient before surgery, since so much surgery is done coming from home and admitted to pre-op. I don't know that if I listened to music the day before at home, it would have any effect that night on my sleep or anxiety in the am going to pre-op. If I was an inpatient, than maybe a massage or videos etc would help. But what if surgery is at 7 am, vs 2 pm, when are the interventions relevant? Further, the type of surgery matters too: coronary bypass vs hernia repair! Hence I don't see how to make this information very useful.


A very interesting paper that is highly relevant for the field.

Surgery - General

It is unrelated to my surgical discipline.

Surgery - General

These results are what I would have expected.

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