Nonpharmacologic Interventions to Reduce Preoperative Anxiety and Optimize Related Outcomes in Spine Surgery: A Systematic Review.

Abstract

This systematic review evaluated prospective studies assessing nonpharmacologic interventions for preoperative anxiety in spine surgery patients. To evaluate the effectiveness of nonpharmacologic interventions compared with standard care to reduce preoperative anxiety among spine surgery patients. Unaddressed preoperative anxiety negatively impacts recovery following orthopedic spine surgery. Beyond reducing anxiety, nonpharmacologic interventions can minimize pain, decrease reliance on opioids or anxiolytics, improve postoperative outcomes, and enhance patient satisfaction. PubMed, Embase, and Scopus databases were searched from database inception to December 2024. We included prospective studies examining the effectiveness of nonpharmacologic interventions delivered the day before or on the day of surgery versus standard care in reducing preoperative anxiety in spinal surgery patients. Data were independently extracted from full-text articles. The review included 7 studies encompassing 548 patients. Four studies assessed educational techniques: 1 used traditional approaches such as booklets and tours, 3 used technology-based methods, 2 focused on music therapy, and 1 investigated relaxing guided imagery. Of the included studies, all 7 demonstrated statistically significant reductions in preoperative anxiety among patients receiving nonpharmacologic interventions compared with standard care. Most studies noted improvements in other outcomes of patient satisfaction, pain management, length of hospital stays, and sleep quality. Nonpharmacologic interventions such as educational techniques, music therapy, and guided imagery reduce preoperative anxiety in spine surgery patients. These cost-effective, minimally invasive approaches may offer a low-risk alternative or complement to medication. Continued research and interdisciplinary collaboration are essential to expand the evidence base and further validate these strategies. Level I.