Virtual Reality Exposure Therapy and Patient Education for Preoperative Anxiety in Pediatrics: Randomized Controlled Trial.

Background: The perioperative environment is complex and may be challenging for patients and guardians to navigate. The emotional burden and stressors inherent to the perioperative process commonly result in preoperative anxiety. Many studies have demonstrated the usefulness of virtual reality (VR) in various patient populations. Objective: The aim of this study is to evaluate the impact of a VR-based preoperative education tool on anxiety levels in pediatric patients undergoing ambulatory ear, nose, and throat surgery, as well as in their guardians. Methods: We performed a single-center prospective randomized controlled trial including children 6-12 years of age, presenting for ambulatory tonsillectomy and/or adenoidectomy, with or without bilateral ear tube insertion. The patients were randomized to receive VR instruction of the perioperative workflow or standard preoperative experience (non-VR). The primary outcome was patient and guardian preoperative anxiety, as measured by the 6-item State-Trait Anxiety Inventory. Results: The study cohort included 107 patient-guardian dyads-51 in the intervention (VR) group and 56 in the control (non-VR) group. Baseline characteristics between the study and control groups were comparable; however, patients in the control group were more likely to report feeling upset compared to the VR group. The VR intervention was associated with reduced preoperative anxiety in patients and guardians compared to the control group. Patients exposed to the VR intervention had higher odds of feeling calm (OR 4.95, 95% CI 2.32-10.61; P<.001) and lower odds of feeling worried (OR 0.25, 95% CI 0.12-0.53; P<.001) compared to the control group. Similarly, guardians in the VR group had higher odds of feeling calm (OR 3.55, 95% CI 1.69-7.49; P=.001) and lower odds of feeling worried (OR 0.45, 95% CI 0.22-0.93; P=.03) compared to the control group. Both patients and guardians exposed to VR were significantly less likely to have moderate or high levels of preoperative anxiety than the control group (patients: OR 0.15, 95% CI 0.05-0.41, P<.001; guardians: OR 0.14, 95% CI 0.06-0.38, P<.001). Conclusions: VR exposure may be effective in reducing pediatric and guardian anxiety. VR may be a suitable alternative to pharmacologic anxiolysis and future studies should compare the effect to premedication techniques.