Effects of immersive virtual reality and non-immersive video distraction on preoperative anxiety in patients undergoing elective abdominal surgery: a three-arm randomised controlled trial

Background: Preoperative anxiety negatively impacts surgical outcomes. This study evaluated the effects of immersive virtual reality (VR) vs non-immersive video distraction on preoperative anxiety, physiological stress, and heart rate in elective abdominal surgery. Methods: In this three-arm randomized controlled trial (NCT05718661), 96 elective abdominal surgery patients were allocated to immersive VR, non-immersive video, or a control group (n=32 per group). Both intervention groups viewed identical relaxing audiovisual content for 15 min via a VR headset or a smartphone screen; controls received standard care. Preoperative anxiety was measured with the Visual Analogue Scale–Anxiety (VAS-A). Physiological stress scores and heart rate were tracked using a wearable smart band before and after the intervention. Results: VAS-A scores worsened in controls (p < 0.001) but decreased significantly in both the VR (p < 0.001) and video (p = 0.002) groups, with no significant difference between the two active interventions (p > 0.05). Device-derived stress scores increased in controls (p = 0.018) and decreased in the video group (p = 0.017), with no change in the VR group (p = 0.568). Heart rate changes did not differ significantly among groups (p < 0.206). Conclusions: Both immersive VR and non-immersive video distraction significantly reduce preoperative anxiety compared with standard care; however, VR is not superior to conventional video viewing. Given its equivalent efficacy, lower cost, and simpler implementation, non-immersive video represents a practical, scalable non-pharmacological strategy for perioperative anxiety management.