Digital Health Interventions in Pediatric Perioperative Care: A Network Meta-Analysis.

Importance Pediatric surgical patients often face considerable perioperative challenges, including anxiety and pain. Digital health interventions offer promise, but their efficacy remains uncertain. Objective To compare the effects of digital health interventions in pediatric perioperative care. Data Sources PubMed, Embase, Web of Science, CENTRAL, and CINAHL databases were searched up to March 1, 2025. Study Selection Randomized clinical trials (RCTs) involving pediatric patients (aged ≤18 years) undergoing surgery with general anesthesia, where digital technology was used as a distraction intervention. Data Extraction and Synthesis A frequentist network meta-analysis with random-effects model was used to calculate standardized mean differences (SMDs) or mean differences (MDs) with 95% CIs. Interventions were ranked using P values, risk of bias assessed using the Cochrane risk of bias tool 2, and certainty of evidence rated using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Main Outcomes and Measures Critical outcomes included pediatric preoperative anxiety, postoperative pain, emergence delirium, and induction compliance. Important but noncritical outcomes encompassed parental preoperative anxiety and postoperative satisfaction. Results Of 7734 RCTs screened, 49 were included involving 4535 youth (pooled mean age, 7.42 years; 95% CI, 6.85 to 7.99; 2989 [65.9%] male) with 7 interventions: virtual reality (VR), 2-dimensional (2D) games, 2D videos, interactive robots, midazolam, control (standard care), and enhanced control (eg, booklets). Compared to control, VR (SMD, -1.14; 95% CI, -1.54 to -0.74; moderate certainty), 2D videos (SMD, -1.08; 95% CI, -1.51 to -0.65; moderate certainty), 2D games (SMD, -1.02; 95% CI, -1.54 to -0.49; low certainty), and enhanced control (SMD, -0.83; 95% CI, -1.53 to -0.13; low certainty) reduced preoperative anxiety. VR (SMD, -1.09; 95% CI, -1.58 to -0.59; moderate certainty), 2D games (SMD, -0.87; 95% CI, -1.62 to -0.12; low certainty), and 2D videos (SMD, -0.56; 95% CI, -1.06 to -0.06; moderate certainty) reduced postoperative pain. VR showed the greatest effect on compliance (MD, -0.93; 95% CI, -1.62 to -0.24; moderate certainty). No significant differences compared to control. Conclusions and Relevance This network meta-analysis of RCTs found that VR, 2D videos, and 2D games significantly reduced pediatric perioperative anxiety and pain and improved induction compliance. These findings support the use of digital health interventions in pediatric perioperative care and their broader clinical adoption.