Application of Virtual Reality in the Management of Preoperative Anxiety: A Systematic Review
Abstract
Introduction. Preoperative anxiety, a common emotional response in patients awaiting surgery, is associated with adverse clinical outcomes, including postoperative complications and increased analgesic consumption. Although traditional anxiolytics are widely used, non-pharmacological approaches such as Virtual Reality (VR) are emerging as promising complementary strategies (Kallush et al., 2018). Thanks to its ability to create immersive environments, VR can reduce anxiety through mechanisms of distraction or familiarization with the surgical setting. To systematically assess the effectiveness of VR in reducing preoperative anxiety, with particular focus on clinical feasibility and the nursing role in its implementation. Methods. A systematic review was conducted following the PRISMA guidelines, querying biomedical databases (PubMed, CINAHL, MEDLINE, Cochrane Library, Scopus, Science Direct) with MeSH terms and keywords. Fifteen studies (2019-2025) on adult patients undergoing elective surgery were included, excluding intraoperative applications or non-surgical contexts. Results. Out of 1,507 participants, 11/15 studies demonstrated a significant reduction in preoperative anxiety with VR, especially in elective surgery. The most effective interventions varied based on the objective: 1) Procedural virtual tour (short duration) for anxiety. 2) Naturalistic environments with music for anxiety and pain. 3) Personalized 3D videos for active patient engagement. Discussion. However, methodological heterogeneity and the lack of direct comparison with anxiolytics limit generalizability. VR is confirmed as a valid option for reducing preoperative anxiety, with potential economic (reduction in medication, operative times) and clinical (improved patient experience) benefits. Standardization of protocols, nursing training, and the integration of multiple elements (e.g., 3D education + nature) represent future areas of development.