A 20-minute virtual reality session eased preoperative anxiety in day surgery

Design

Single-centre, open-label randomised controlled trial

Population

106 adults with moderate to severe preoperative anxiety in day surgery

Primary outcome

Change in STAI-YA score before transfer to theatre

Effect

Adjusted difference −18.7 points (95% CI −21.4 to −16.1)

This single-centre, open-label trial in France randomised 106 adult day-surgery patients with moderate to severe anxiety (STAI-YA above 45) to usual care or usual care plus one 20-minute immersive virtual reality session of calm natural scenes before surgery.

Anxiety fell much more with virtual reality: the adjusted between-group difference in STAI-YA change was −18.7 points (95% CI −21.4 to −16.1). Benzodiazepine use, postoperative pain and unplanned admission did not differ. Six control patients and none in the virtual reality group needed morphine in recovery. Satisfaction was high in both groups.

The effect on anxiety is large, but the outcome is self-reported and patients knew which group they were in, which inflates subjective scores. There was no effect on the clinical outcomes that would justify cost. It is a low-risk option for anxious patients where headsets are available, not a replacement for good preoperative communication.

• Screen day-surgery patients for preoperative anxiety on arrival.
• Consider offering a short virtual reality session to highly anxious patients where equipment is available.
• Do not expect virtual reality to reduce premedication, postoperative pain or admissions, based on this trial.
• Keep explaining the plan in person; information remains a strong anxiolytic.

Why it matters

Preoperative anxiety is common and usually managed with drugs, and this offers a drug-free option with high acceptability.

Don't overread it

The open-label design and self-reported outcome likely exaggerate the effect, and no clinical outcomes improved.

The statistics, in plain English

A 19-point fall on a scale where the median start was 49 is large. But the trial was open-label, so patients knew they had the intervention, and self-reported anxiety is especially sensitive to that. The morphine difference rests on six events and should be treated as a chance finding until repeated.

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