Effects of virtual reality-based interventions on preoperative anxiety in patients undergoing elective surgery with anesthesia : systematic review and meta-analysis

Abstract

Background: Preoperative anxiety is a common yet often neglected problem for patients undergoing surgery. Virtual reality (VR)–based intervention is a promising alternative with benefits for managing preoperative anxiety. However, the components of VR-based intervention and its effectiveness on preoperative anxiety in patients undergoing elective surgery with anesthesia remain unclear. Objective: This study aimed to identify the major components (ie, device, medium, format, and duration) of VR-based interventions and summarize evidence regarding their effectiveness in reducing preoperative anxiety in patients undergoing elective surgery with anesthesia. Methods: Allied and Complementary Medicine, Chinese University of Hong Kong Full Text Journals, CINAHL via EBSCOhost, Cochrane Library, Joanna Briggs Institute EBP Database, EMBASE, MEDLINE via OvidSP, PubMed, PsychINFO, Scopus, China Journal Net, and WanFang Data Chinese Dissertations Database were searched from inception to February 2025. Randomized controlled trials (RCTs) of VR-based interventions for patients undergoing elective surgery with anesthesia were included. The Cochrane Collaboration’s tool was used for risk of bias assessment. A random effect model was used for pooling the results. Results: A total of 35 RCTs with 3341 patients (female: n=1474, 44.1%) were included in this review, of which 29 RCTs were included for meta-analysis. Compared with usual care, VR-based interventions showed substantial benefits in decreasing preoperative anxiety in patients undergoing elective surgery (standardized mean difference [SMD] 0.65, 95% CI 0.37-0.92; P<.001). Regarding the subgroup analysis, VR-based intervention showed significant but moderate effects on preoperative anxiety in the pediatric population (SMD 0.77, 95% CI 0.32-1.22; P<.001) compared to the adult population (SMD 0.58, 95% CI 0.23-0.93; P=.001). The distraction approach showed more significant effects (SMD 0.73, 95% CI 0.24-1.21; P=.004) on preoperative anxiety than the exposure approach (SMD 0.61, 95% CI 0.27-0.95; P<.001). Conclusions: Patients undergoing elective surgery with anesthesia may benefit from VR as a novel alternative to reduce preoperative anxiety, especially pediatric patients via the distraction approach. However, more rigorous research is needed to confirm VR’s effectiveness.