Effects of a multistage virtual reality intervention on perioperative anxiety and recovery in patients undergoing elective gynecological surgery: a prospective single-blind randomized controlled trial

Preoperative anxiety is a common concern among adult patients undergoing elective surgery and is associated with poor outcomes.Virtual reality (VR)-based interventions have emerged as simpler, safer, and more effective alternatives than traditional care in reducing anxiety in patients undergoing gynecological surgery. A prospective, single-blind, randomized controlled trial design was conducted, involving 109 American Society of Anesthesiologists physical status I-II patients scheduled for gynecological laparoscopic surgery, who were randomly divided into a control group, a preoperative visit Virtual Reality group, and a preoperative visit combined with surgical waiting area Virtual Reality group .The primary outcome, preoperative anxiety, was assessed using the Amsterdam Preoperative Anxiety and Information Needs Scale, and secondary outcomes included sleep quality stress and pain and postoperative satisfaction. Interventions and measurements were performed at 4 time points: the start of the clinical session (T0), after the ward visit intervention (T1), in the surgical waiting area (T2), before anesthesia induction (T3), and after surgery (T4). The results showed that intervention group 2 exhibited significantly lower anxiety scores than the control group at T2 and T3 (β=-4.15, p < 0.001; β=-5.88, p < 0.001), and postoperative acute pain scores (H = 14.574, p < 0.001) and satisfaction (H = 38.027, p < 0.001) also improved significantly. However, anxiety and stress levels were transiently elevated after the initial intervention (T1). Our study suggests that multiple VR interventions can effectively reduce preoperative anxiety and improve the perioperative experience through exposure and distraction mechanisms.However, it is important to note the possible short-term transient elevation in anxiety and stress levels after the initial intervention. This study was retrospectively registered on February 21, 2025, at the Chinese Clinical Trial Registry (which is part of the World Health Organization International Clinical Trials Registry Platform, registration number ChiCTR2500097598). All patients included in the statistics were enrolled after this date, and each patient signed a written informed consent form.