Efficacy of Virtual Reality‐Based Intervention for Reducing Preoperative Anxiety in Adult Surgical Patients: A Randomized Controlled Trial

BACKGROUND: Preoperative anxiety affects a substantial proportion of surgical patients and may adversely influence perioperative outcomes. Virtual reality (VR) technology offers an innovative approach for anxiety management, yet evidence regarding its efficacy in surgical settings remains limited. OBJECTIVE: This study aimed to evaluate the effectiveness of an immersive VR-based intervention for reducing preoperative anxiety among adult patients undergoing elective abdominal surgery. METHODS: A prospective, single-center, randomized controlled trial was conducted from March 2023 to December 2024. Three hundred eight patients scheduled for elective abdominal surgery were randomly allocated to either the VR intervention group (n = 155) or the standard care control group (n = 153). The VR group received a 10-15 min immersive relaxation experience prior to anesthesia induction. The primary outcome was pre-induction anxiety measured using the State-Trait Anxiety Inventory, State subscale (STAI-S). Secondary outcomes included intraoperative cooperation scores, physiological stress markers, and patient satisfaction. RESULTS: Patients in the VR group demonstrated significantly lower pre-induction STAI-S scores compared to controls (36.5 ± 10.5 vs. 48.0 ± 10.9, mean difference -11.5, 95% CI -13.9 to -9.2, Cohen's d = 1.08, p < 0.001). The VR group also exhibited higher intraoperative cooperation scores (82.8 ± 9.3 vs. 74.8 ± 11.8, mean difference 8.0, Cohen's d = 0.75, p < 0.001) and attenuated physiological stress responses including heart rate (82.5 ± 12.8 vs. 89.5 ± 12.4 bpm, mean difference -7.0, Cohen's d = 0.56, p < 0.001), systolic blood pressure (133.3 ± 15.0 vs. 142.0 ± 14.5 mmHg, mean difference -8.7, Cohen's d = 0.59, p < 0.001), and serum cortisol (14.9 ± 4.3 vs. 20.1 ± 4.8 μg/dL, mean difference -5.2, Cohen's d = 1.14, p < 0.001). The VR group reported higher satisfaction scores (8.1 ± 1.1 vs. 7.4 ± 1.3, p < 0.001). Subgroup analyses revealed consistent benefits across surgery types, anesthesia modalities, and demographic characteristics. Adverse events were minimal, with only 4.5% of VR participants reporting mild transient symptoms including dizziness (n = 3, 1.9%), headache (n = 3, 1.9%), and eye strain (n = 1, 0.6%), all of which resolved spontaneously within minutes. CONCLUSIONS: Immersive VR-based intervention effectively reduces preoperative anxiety and improves patient cooperation in adults undergoing elective abdominal surgery. This non-pharmacological approach represents a promising adjunct to standard perioperative care protocols.